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To evaluate the impact of infarct size on morbidity and mortality, blood samples were drawn for CPK-MB determination in 144 consecutive patients with first acute myocardial infarction. Enzymatically estimated infarct size was significantly higher in patients who developed in-hospital arrhythmias, congestive heart failure or mechanical complications, or died. After hospital discharge, infarct size was correlated with the extension score of resting thallium-201 perfusion defects. However, infarct size did not predict the occurrence of long-term complications. Thus, infarct size affects the short-term prognosis. The long-term follow-up is determined by the complex interaction of left ventricular dysfunction, residual ischemia, and arrhythmogenic potential.