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Aims: Today's knowledge concerning the progression of coronary artery disease (CAD) is mainly derived from randomised clinical studies performed in patients with stable CAD. Data on atherosclerosis progression (AP) after myocardial infarction are limited. The aim of this study was to assess the AP in such a population of patients., Methods and Results: A total of 186 patients were analyzed. After exclusion of patients not suitable for quantitative coronary angiography analysis, the final group was comprised of 154 patients. AP was recognized in 93 (60.4%) patients. A multivariate regression analysis revealed that the risk of AP in patients increases with lack of adequate microvascular perfusion, as assessed by the thrombolysis in myocardial infarction (TIMI) myocardial perfusion grade (TMPG) score (odds ratio [OR] 4.13; 95% confidence interval [CI] = 1.17-14.53), non-smoking status and lower baseline cholesterol value (OR = 2,74; 95% CI 1.19-6.31 and OR = 1.44; 95% CI = 1.04-1.98, respectively). Moreover, the risk of progression of a pre-existing coronary lesion was enhanced the most when the baseline minimal lumen diameter was greater (OR = 2.34; 95% CI = 1.83-3.00), and a lack of adequate microvascular perfusion (OR = 3.12; 95% CI = 1.67-5.85) was the strongest predictor of risk of developing new coronary lesions., Conclusions: Atherosclerosis progression concerns over 60% of patients 12 months after acute myocardial infarction. Poor myocardial perfusion, as assessed by TMPG score, may be a simple tool for the identification of patients at greater risk of atherosclerosis progression, especially the development of new lesions.