Twenty patients (13 men and 7 women; mean age 61 +/- 12 years) with > 30 minutes chest pain and new ST-segment elevation who were treated with reperfusion therapy underwent technetium 99m sestamibi imaging and two-dimensional echocardiography simultaneously before and within 2 hours of each test after acute reperfusion therapy. Nine patients had anterior wall myocardial infarction. Fifteen patients were initially treated with intravenous thrombolytic agents, and five patients underwent urgent percutaneous transluminal coronary angioplasty. Both myocardial perfusion defect and wall motion score index (WMSI) improved after reperfusion therapy (perfusion defect from 28% to 15%, WMSI from 1.68 to 1.45, respectively; p < 0.005). The overall correlation between WMSI and perfusion defect as a measure of myocardium at risk was significant during the acute phase (r = 0.71) and at hospital dismissal (r = 0.71). Thus myocardial perfusion defect and wall motion abnormalities correlated fairly well in patients with acute myocardial infarction during the acute phase and at predismissal study.