Background and Objectives Despite of great efforts to define the best strategy for multivessel disease in acute myocardial infarction (AMI), there was conflict between percutaneous coronary intervention (PCI) for infarct related artery (IRA) only and total revascularization. Methods A postspective, multicenter, randomized trial was conducted to examine 4514 patients who had an AMI and had ��� 75% stenosis in at least 2 major coronary artery. 3085 patients were treated with PCI for IRA (Group I) and 1429 patients with total revascularization (Group II). We excluded the patients treated with staged PCI during hospital index to clarify the patients group. Primary outcomes were death at 6, 12 months and secondary outcomes were major adverse cardiac event (MACE). Results There were no significant differences in mortality at 6 and 12 months between two groups (mortality at 6 months: 2.9% in Group I vs. 2.4% in Group II, p=0.555, mortality at 12 months: 4.7% in Group I vs 3.8% in Group II, p= 0.351). However, there were singnificant differences in MACE between two groups (MACE at 6 months: 11.7% in Group I vs. 8.1% in Group II, p=0.002, MACE at 12 months: 19.2% in Group I vs. 13.6% in group II, p=0.001). These differences came from target lesion revascularization (2.7% vs. 4.5% at 12 months, p=0.017) and non-target vessel revascularization (7.6% vs 2.5% at 12 months, p<0.001), which means that there was tendency to treat the vessels, during follow-up period, were not treated at the time of AMI. Conclusion In multivessel disease in AMI, total revascularization had no survival benefit compared with PCI for IRA only. During follow-up, there was tendency to treat the vessels which was not treated at the time of AMI.