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Fifty-nine consecutive coronary care patients, clinically evaluated as not having acute myocardial infarction (AMI) and with a duration of symptoms of less than 6 hours on admission, were studied. Serum myoglobin (MG) and creatine kinase (CK) were determined sequentially during the first 25 hours. Two groups are identified, one with a pattern of a serum MG peak followed by a CK peak and one without. Twenty-four patients had a serum MG peak of 137 plus or minus 33 micrograms x 1(-1) followed by a CK peak of 1.6 plus or minus 0.9 microkat x 1(-1). Values above th reference limits were found in 19 patients for MG and in 5 for CK. After the onset of symptoms, the peaks were observed at 5.3 plus or minus 2.8 (MG) and 12.7 plus or minus 5.3 (CK) hours. Compared to the group without MG and CK peaks, ECG alterations were more frequent in the group with peaks, 20/24 (84%) versus 15/35 (43%). The entire patient group had the same 2-year incidence of major coronary events as patients with AMI, but it tended to be higher in patients with MG/CK release.