To determine the safety and efficacy of the use of intravenous streptokinase in a 110-bed rural community hospital, we studied 28 consecutive patients with clinical and ECG evidence of acute myocardial infarction. Twenty (74 percent) of the 27 patients who had cardiac catheterization after treatment with intravenous streptokinase were found to have a patent artery supplying the infarcted area. One patient (3.5 percent) died of intractable heart failure, 2 (7 percent) had ventricular fibrillation, and 9 (32 percent) had ventricular tachycardia. Six patients (21 percent) had minor bleeding problems, and 1 developed a pseudoaneurysm at the catheterization site. We maintained close communication with a consulting cardiology group who provided additional medical or surgical therapy in a tertiary medical center for patients who needed it. We believe that intravenous streptokinase can be safely and effectively used in a rural community hospital.