Background <p>The diagnosis and treatment of acute myocardial infarction (AMI) complicated with multivessel disease (MVD) by percutaneous coronary intervention (PCI) has been well recognized. However, the use of PCI in non–infarct-related coronary arteries remains controversial. We aimed to study the clinical outcome of complete vs. culprit-only revascularization for AMI with MVD before discharge.</p> Methods <p>173 AMI with MVD who received emergent PCI between January 2013 and December 2018 were retrospectively analyzed. Patients were divided into complete revascularization (CR) group (<i>n</i> = 85) and culprit-only revascularization (COR) group (<i>n</i> = 88). Major adverse cardiovascular and cerebral events (MACCE) at 1, 6, and 12 months after PCI were compared, including recurrent angina, recurrent MI, in-stent thrombosis, new-onset atrial fibrillation (AF), and worsen heart failure (HF).</p> Results <p>Baseline characteristics of two groups were comparable. There was no significantly statistical difference in MACCE between COR group and CR group, 36.2% vs. 33.3% (<i>P</i> = 0.715), 42.0% vs. 29.7% (<i>p</i> = 0.125) and 44.9% vs. 36.5% (<i>p</i> = 0.304) at 1-, 6- and 12-month follow up respectively. Compared with the CR group, a higher rate of recurrent angina was in COR group (20.3% vs. 5.4%, <i>P</i> = 0.007) at the 6th month. Subgroup analysis showed that hypertensive patients benefited more from complete revascularization at the 6- (OR:0.31, 95%CI: 0.13–0.76) and 12-month (OR:0.38, 95%CI: 0.16–0.90) follow up.</p> Conclusions <p>Complete revascularization before discharge does not supply additional benefit on long time MACCE as compared with culprit-only intervention strategy in patients presenting with AMI for urgent PCI with multivessel disease.</p>