Background: Despite the effectiveness of lipid-lowering therapy and beta-blockers in altering subsequent cardiovascular mortality, studies have documented low treatment rates in patients with established coronary artery disease. The aim of this study was to determine the effects of combined simvastatin and carvedilol therapy in patients with ischemic heart failure (IHF). Methods: We studied 302 patients with IHF who underwent percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) [left ventricular ejection fraction (LVEF) < 40%] between January 2001 and June 2003. The patients were divided into four groups: combination group (n=160, 61.3짹11.2 years, men 70%), simvastatin only group (n=216, 61.8짹10.3 years, men 72%), carvedilol only group (n=242, 62.5짹9.8 years, men 68%), neither treatment group (n=54, 65.3짹12.4 years, men 74%). Results: At 6-month after PCI, the LVEF was improved most significantly in combination group. During follow-up, 24 patients died (3.8%, 6.9%, 8.3%, 16.7%, respectively, p=0.001 in combination vs. neither, p=0.025 in simvastatin only vs. neither, p=0.060 in carvedilol only vs. neither) and 20 had a reinfarction (2.5%, 4.6%, 4.5%, 7.4%, respectively, p=NS) and in-stent restenosis was occurred in 77 patients (20%, 21.3%, 22.3%, 31.5%, respectivley) and target lesion revascularization was performed in 70 patients (18.8%, 19.9%, 20.7%, 27.8%, respcetively). The results on major adverse cardiovascular events (MACE) showed that treatment with simvastatin alone was associated with a relative risk reduction of 44% (p=0.001) and carvedilol alone with a relative risk reduction of 40% (p=0.001) and the combination of simvastatin and carvedilol was associated with a relative risk reduction of 53% (p <0.001) compared with neither treatment group. The independent predictors for 1-year MACE were no statin and beta-blocker treatment, high C-reactive protein and old age. Conclusion: Combined therapy with simvastatin and carvedilol had a positive impact on the end points of cardiovascular death and total MACE and seems to have additive effect on these end points in patients with IHF who underwent PCI.