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Abstract: Objective: Acute anteroseptal ST-segment elevation (STE) myocardial infarction (AS-STEMI), defined as STE limited to leads V1 to V3, has historically been associated with a smaller infarct size than extensive anterior STEMI (EA-STEMI), in which STE extends to leads V4 to V6. We compared the differences in global and regional wall motion by transthoracic echocardiography between patients with AS-STEMI and EA-STEMI. Methods: Patients who presented with anterior STEMI and underwent primary percutaneous coronary intervention between January 2008 and March 2011 were included. For each subject, a transthoracic echocardiogram that was performed within 24hours of admission was interpreted by an independent investigator blinded to the patient''s electrocardiographic data. Results: Of the 65 subjects who met our inclusion criteria, 30 had AS-STEMI and 35 had EA-STEMI. No differences were observed between groups in baseline characteristics or the mean number of hypokinetic, akinetic, and dyskinetic segments. Apical inferior segment dysfunction occurred more often in patients with EA-STEMI than in patients with AS-ASTEMI (71.4% vs 43.3%; P =.04). Distribution and extent of wall motion abnormalities were similar between patients with AS-STEMI and those with EA-STEMI. Conclusion: The term AS-STEMI may be misleading, as it implies that only the anteroseptal segments are involved. We show that regional dysfunction in patients with AS-STEMI extends beyond the anteroseptal region. [Copyright &y& Elsevier]