An analysis of 80 patients who had elective coronary arteriography within 6 months after hospital dismissal for acute myocardial infarction showed that approximately two-thirds had multivessel coronary disease. The study is consistent with others reported in the recent literature in suggesting that most patients who survive myocardial infarction have multivessel disease. High early and late post-myocardial infarction mortality is comparable to that described for patients with two- and three-vessel occlusive disease. Knowledge of specific coronary anatomy and left ventricular function is critical in assessing post-myocardial infarction prognosis. This information is also important in defining optimal medical or surgical treatment. Unfortunately, the severity of the subjective clinical syndrome does not correlate well with the degree of anatomic findings or the prognosis. Properly selected surgical intervention may be one approach to modifying the high post-myocardial infarction mortality, which has not changed materially in the past several decades.