This study investigated the clinical significance of hypoxemia without apparent clinical congestive heart failure in patients with acute myocardial infarction (AMI). Sixty-two patients with AMI of the Killip group I and Forrester subset I state were stratified into a hypoxemia group and a normoxemia group. The increase in the neutrophil count and the severity of the coronary artery disease as graded by Gensini's score were significantly higher in the hypoxemic group. The cardiac index was lower in hypoxemic than normoxemic patients. Myocardial scintigraphy revealed no acute difference in defect scores (DS) or left ventricular ejection fraction (LVEF) between the two groups, but DS was significantly higher (p < 0.01) and LVEF was lower (p < 0.01) in the hypoxemic group 2 years after infarction. Patients with hypoxemia have a more severe angiographic coronary pathology than normoxemic patients, and latent cardiac hypofunction occurs.