30 patients with acute myocardial infarction were examined by means of two-dimensional echocardiography, clinically classified according to Killip and the requisite CK peak level was determined. An echocardiographic score system was used to quantify the wall movement disturbances. The patients were subdivided into 3 groups according to clinical course during hospitalization (average 4 weeks) and these data correlated to Killip classification, CK peak level and echocardiographic score system determined on admission: Group 1 (9 patients with uncomplicated myocardial infarction), group 2 (11 patients with complicated posterior wall infarction), group 3 (10 patients with complicated anterior wall infarction). Cardiogenic shock, left ventricular pump failure, life-threatening arrhythmias and death were defined as complications. Mean value difference of the scores between group 1 and group 2 were significant (alpha less than 1%) and between group 1 and group 3 very significant (alpha less than 0.1%). With respect to CK, a significant difference existed between group 1 and group 2 and also between group 1 and group 3 (alpha less than 5%). Killip classification was specific, but very insensitive (64%). The echocardiographic score system is suitable for the prediction of in hospital course after myocardial infarction, and is superior to CK peak level determination.