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To estimate the extent of myocardial infarction after coronary artery reperfusion, serum levels of cardiac myosin light chain (LC) I and creatine kinase (CK) were determined serially in 49 patients with acute myocardial infarction. Intracoronary thrombolysis was successful in 25 patients (reperfusion group), and 24 patients were treated in a conventional manner (control group). The peak level of CK appeared significantly earlier in the reperfusion group (1 1.3 + 3. 1 hr, mean + SD) than in the control group (21.6 ± 7.2 hr). Cumulative release of CK was significantly related to angiographically determined left ventricular ejection fraction 1 month after the attack in both groups (r = -.50; -.45, respectively). However, the amount of cumulative release of CK in the reperfusion group was greater compared with that in those with the same left ventricular ejection fraction in the control group. Peak appearance time of LCI was almost equal in the two groups (3.8 ± 1.4 vs 3.9 ± 1.2 days). Peak levels of LCI were related to the left ventricular ejection fraction in the reperfusion group (r = -.63) and in the control group (r = -.74), and the slopes of their regression lines were similar. The cardiac index obtained on the day of onset in the two groups was related to peak levels of LCI but not to total release of CK. These results suggest that serum levels of LCI reflect the changes in left ventricular function after acute myocardial infarction, regardless of the presence of coronary reperfusion. Thus, serial determinations of LCI in serum facilitate noninvasive assessment of the effects of intracoronary thrombolysis on infarct size. Circulation 76, No. 6, 1251-1261, 1987 IT HAS BEEN SHOWN that the intracoronary infusion of thrombolytic drugs can bring about coronary artery recanalization and this has been proposed as a way of reducing the extent of acute myocardial infarction. 1, 2 Although recent clinical investigations suggest beneficial effects of intracoronary thrombolysis,-5 many laboratory studies have pointed out the deleterious effects of coronary reperfusion, including massive myocardial hemorrhage, refractory arrhythmias, or noreflow phenomenon.68 Therefore, for evaluation of salvage and damage to the myocardium after throm-