Background : There was little data concerning the clinical outcome of patients with acute myocardial infarction (AMI) and near normal angiogram. The aim of this study was to evaluate the clinical outcome and the prognosis of the patients with near-normal coronary angiogram. Methods and Results : The subjects were divided into three groups according to findings from coronary angiograms performed between Sep 2005 and Nov 2006. Among 8510 patients, registered in Korea AMI Registry, 372 patients (Group I : mean age 59.0 짹 12.9 years, female 39.1% ) had near normal coronary arteries at the angiogram, 6136 patients (Group II : 62.6 짹 12.6 years, female 26.4 %) had one or two vessel disease, and 2002 patients (Group III : 67.1 짹 11.3 years, female 32.6 %) had three vessel or left main disease. Clinical characteristics, in-hospital mortality, and major cardiac adverse events (MACE) were analyzed. Group I was younger (Group I : 59.0 짹 12.9 years, Group II : 62.6 짹 12.6 years , and Group III : 67.1 짹 11.3 years, p<0.001 ), had the lower prevalence of DM (Group I : 15.0 %, Group II : 24.3 % , and Group III : 37.9 %, p<0.001), and showed the higher percentage of previous angina history (Group I : 59.1 %, Group II : 36.4 % , and Group III : 39.1 %, p=0.013 in Group I vs. II, p=0.034 in group I vs. III) than other two groups. Group III showed higher incidence of in-hospital mortality, but there was no significant difference between Group I and Group II (6.9 % in Group III, 2.6 % in Group II, and 2.2 % in group I, p<0.001 in Group II vs. III and Group I vs. III and p=0.952 in Group I vs. II). Furthermore, MACE at 1 month, 6 months and 12 months, revealed no significant difference between Group I and II (1 month MACE : 1.2 % in Group I and 1.9 % in Group II, p=0.740 ; 6 month MACE : 4.2 % in Group I and 6.7 % in Group II, p=0.403 ; 12 month MACE : 7.8 % in Group I and 12.2 % in Group II, p=0.359). Conclusion: The patients with near normal coronary angiogram in the acute myocardial infarction had a similar clinical outcome and prognosis compared with one or two vessel disease in the acute myocardial infarction.