There are patients in whom left ventricular (LV) wall motion decreases in the noninfarcted region and LV systolic function declines globally despite the presence of a localized myocardial infarct attributable to narrowing or occlusion of a single coronary artery. This study examines angiographic characteristics of patients with chronic hypokinesia of noninfarcted myocardium after anterior wall acute myocardial infarction (AMI) due to narrowing of a single coronary artery, namely, the left anterior descending (LAD) artery. The LV ejection fraction, abnormalities in the motion of the noninfarcted LV inferior wall (SD/chord value by Sheehan's technique), the angiographic characteristics of the infarct-related coronary artery, the effect of acute reperfusion therapy, and presence of coronary risk factors were examined in 85 consecutive patients. The SD/chord value in the noninfarcted region showed a positive correlation with the LV ejection fraction (r = 0.505, p <0.0001). By multivariate analysis, hypertension (odds ratio = 0.53, 95% confidence interval [CI] 0.36 to 0.80), an infarct-related narrowing proximal to the origin of the first diagonal branch (odds ratio = 0.56, 95% CI 0.38 to 0.84), and patency of the infarct-related lesion during AMI (odds ratio = 1.56, 95% CI 1.03 to 2.30) were independent predictors of wall motion in the noninfarct region. In some patients with single-vessel anterior wall AMI, the motion of the noninfarcted inferior LV wall decreases during the chronic stage and cardiac function declines severely. In most of these patients, the infarct-related narrowing or occlusion is proximal to the origin of the first diagonal branch of the LAD artery.