We investigated the effects of the strict adherence to ACC/AHA guidelines in decision making for coronary angiography in patients who survived after a Q wave myocardial infarction (MI). This prospective observational study included 280 consecutive patients (≤ 75 years) in the Northwestern Region of Greece who survived a Q wave MI. Followup ranged from 22 to 29 months (mean: 26 months). Coronary angiography and revascularization rates in the early post- MI period (2 months after the index event) and mortality and morbidity during the follow-up period were the main outcome measures. In the early post-MI period, coronary angiography, percutaneous coronary intervention and coronary artery bypass surgery were performed in 48%, 16% and 14% of the patients, respectively. During the follow-up period 24 (8.2%) patients died (cardiac death: 21; 87.5%), and 15 (5.1%) suffered a re-infarction. Diabetes (OR 4.63, 95% CI 1.44 to 14.48, p=0.010), anterior MI (OR 4.54, 95% CI 1.51 to 15.15, p=0.007) and no prescription of beta-blockers (OR 9.86, 95% CI 2.69 to 18.61, p=0.001) were predictors of death at follow-up. Advanced age (OR 1.07, 95% CI 1.00 to 1.14, p=0.045) was the only predictor of re-infarction. We conclude that a) Implementation of published AHA/ACA guidelines in a Greek population resulted in coronary angiography and revascularisation procedures in the early phase of Q wave MI with rates of 48% and 30%, respectively. b) The two-year post discharge mortality was 8.2% and re-infarction rate 5.1%. c) Diabetes, anterior MI and lack of prescription of beta-blockers were strong predictors of mortality; advanced age being the only predictor of re-infarction.