The impacts of multivessel disease(MVD) with chronic total occlusion in acute myocardial infarction(AMI) patients are not clearly known. Moreover, there is only limited information on the effects of successful recanalization of chronic total occlusion(CTO) in AMI patients. We investigated the effects of presence of CTO and successful recanalization of CTO on mortality in patients with AMI. We studied 713 consecutive patients with AMI who were admitted in our hospital and underwent coronary angiography between 2006 and 2007. Among 713 patients, 284 patients(39%) had MVD, and 53 patients(7%) had CTO lesions. During 12 months follow-up, 51 patients(7.2%) died. One year survival rate of single vessel disease was higher than that of MVD(94.5% vs 90.4%, p=0.022). However, one year survival rate of MVD with CTO was not different from MVD without CTO (90.4% vs 90.4%, p=0.945). Among 53 patients with CTO, 22 patients had successful recanalization of CTO and they all survived for 12 months, although there were 5 death in other 31 patients with CTO (p=0.051). After correction for the baseline differences, MVD, age older than 65 years, ST-elevation MI, MI related to left anterior descending artery were an independent predictor for 1 year mortality. Conclusion: In AMI patients, the presence of a CTO was not a significant predictor of one year mortality, however MVD itself was a significant predictor. Successful recanalization of CTO in AMI patients had modest effect on mortality, although statistically non-significant. Further large studies are needed to investigate the impact of successful recanalization of CTO in AMI patients.