In a retrospective study including 1888 consecutive patients (pts) with acute myocardial infarction (AMI) admitted in the years 1989-1993 to the CCU, the relationship between sex, age, history of angina, location of infarction and heart wall rupture has been studied in a multivariate regression model. Female sex (p = 0.0013), older age (p = 0.0001), first angina during the AMI (p = 0.001) were indicative for significantly higher risk of rupture. Women are at higher risk only with anterior wall AMI (p = 0.0393). This risk increases continually with age, more in pts with inferior wall AMI than anterior wall AMI (p = 0.339). Females over the age of 75 with anterior wall AMI and first AP, and males and females over 83 with inferior wall AMI and first AP are at the highest risk of rupture (48.6% of deaths). We conclude that the defined high risk pts should be carefully monitored concerning the signs of impending heart wall rupture.