Objective-To determine whether serum myoglobin, creatine kinase, and creatine kinase-MB measured at admission by rapid, compact, and easy to use automated quantitative analysers (results within 10 min) helped the early identification of acute myocardial infarction. The results were compared with the data obtained from the electrocardiograms recorded at admission. Design-A prospective study. Setting-Coronary care unit. Patients-94 consecutive patients with suspected myocardial infarction. Myocardial infarction was subsequently confirmed in 44 patients and excluded in 50. Methods-All admission serum myoglobin, creatine kinase, and creatine kinase-MB were measured by clinical staff using analysers in the coronary care unit. An admission electrocardiogram was obtained from all patients. Results-The sensitivity, specificity, and predictive accuracy for diagnosing myocardial infarction were: electrocardiogram 68%, 100%, and 85%; myoglobin 57%, 100%, and 80%; creatine kinase (threshold of 190 Ufl) 34%, 98%, and 68%; creatine kinase-MB (threshold of 25 Uf1) 43%, 100%, and 73%. When the electrocardiographic and myoglobin data were combined the sensitivity improved to 91%, diagnostic accuracy to 96%, with specificity of 100%. The results for the electrocardiogram and creatine kinase-MB were 80%, 90%, 100% respectively and those for the electrocardiogram with creatine kinase were 80%, 89%, 98% respectively. Conclusions-Admission myoglobin, creatine kinase, and creatine kinase-MB measurements were not as useful as the electrocardiogram for the diagnosis of acute myocardial infarction. Combining the electrocardiogram and myoglobin data substantially improved the sensitivity and predictive accuracy for the diagnosis of acute myocardial infarction. (Br Heart J 1994;71:311-315) Earlier biochemical identification of patients with acute myocardial infarction is desirable. These patients may benefit from early application of interventions such as thrombolysis.I Though the electrocardiogram is widely used for diagnosing acute myocardial infarction its sensitivity can be as low as 60%.2 3 Myoglobin, creatine kinase (CK), and creatine kinase-MB (CK-MB) are released early after myocardial infarction.F8 Until recently, they could only be estimated either semi-quantitatively9 or by time consuming laboratory based procedures.'011 This made such estimation unsuitable for the early diagnosis of myocardial infarction.'2 Novel rapid analysers for measuring myoglobin CK, and CK-MB are now available. These give a quantitative result within 10 minutes of blood collection. The analyser is compact and can be placed in the coronary care unit and be used by clinical staff. This has made the early biochemical identification of infarct patients feasible.We used the rapid analyser in a prospective trial to evaluate the potential of rapid myoglobin, CK, and CK-MB analysis in the early identification of acute myocardial infarction to see whether this approach gave useful information in addition to that already available from the presenting electrocard...