Data collected by the Augsburg Infarct Register during 1985-1988 were analysed. There were 3,729 cases of acute myocardial infarct (2,672 men and 1,057 women; mean age 62.8 [25-74] years). Before hospitalization cardiac arrest had occurred in 1,401 persons (38%); resuscitation attempts were made in 494 of them (34%). A doctor witnessed the arrest in 243 persons, 13 of whom survived the subsequent 28 days. But none of 640 persons who had a cardiac arrest when only lay people were present survived the first day: resuscitation had been attempted in 39. 518 persons died before hospitalization without anyone present. In the first hour after infarction 30% died, within 4 hours 38% of the total group. The median pre-hospitalization time was 3.11 (range 1.67-8.05) hours. 42% of the patients first called their doctor, 26% went to him (her). This caused decisive delays. The thrombolysis rate was 24%, if the pre-hospital interval was under 6 hours (mortality rate 6% with, 12% without thrombolysis). The prognosis of acute myocardial infarction could be improved by specific instructions to high-risk patients and their relatives and by widening emergency care provisions.