To identify clinical syndromes benefiting from post-myocardial infarction (MI) left ventricular (LV) aneurysmectomy, 145 consecutively operated patients were followed a mean of 23 +/- 2 months postoperatively. Of the 145 patients, 49% had single-vessel (SV) coronary artery disease (CAD) (> or = 70% stenosis), 49% had multivessel (MV) CAD, and 2% (3 patients) had an unknown extent of CAD. Patients with SV-CAD and MV-CAD had similar distributions of age, sex, aneurysm location, LV end-diastolic pressure, LV ejection fraction, and scar size. In the SV-CAD group, the major operative indication was incapacitating heart failure (CHF), whereas in the MV-CAD group, the major operative indication was angina, often in combination with CHF. Coronary bypass grafting was done in 17/71 (24%) of SV-CAD and 64/71 (90%) of MV-CAD. Acute (30-day) postoperative survival was 89% (129/145) overall, and long-term survival 73%. Throughout the follow-up period, survival was similar in SV-CAD and MV-CAD. At follow-up, 89% of all survivors had CHF symptoms of functional Class II severity or less, and 97% of survivors had angina of Class II severity or less. Improvement in angina was most striking in the multivessel group whose angina had been more severe preoperatively. Thus, in patients undergoing LV aneurysmectomy and concomitant coronary revascularization: 1) SV-CAD is common; 2) SV-CAD has predominantly CHF preoperatively and usually relief of CHF postoperatively; 3) MV-CAD has both angina and CHF preoperatively, with symptomatic relief of both postoperatively; and 4) preoperative CAD extent does not influence survival.