OBJECTIVE--To evaluate as predictors of reinfarction and mortality tissue plasminogen activator antigen and activity before and after venous occlusion, plasminogen activator inhibitor, von Willebrand factor, and established risk factors. DESIGN--Prospective study with a mean observation time of 4.9 years. SETTING--Secondary referral centre, the Department of Internal Medicine, University Hospital of Umeå. PATIENTS--123 consecutive survivors of myocardial infarction under the age of 70 years. MAIN OUTCOME MEASURES--Reinfarction and deaths from all causes. RESULTS--23 patients died and 36 patients had at least one reinfarction. High concentrations of von Willebrand factor were independently associated with both reinfarction and mortality. A history of angina at entry into the study was also independently associated with reinfarction and mortality. Hypertension was independently associated with mortality but not with reinfarction. None of the fibrinolytic or lipid variables was associated with reinfarction or death. CONCLUSION--A high concentration of von Willebrand factor was a novel index of increased risk for reinfarction and mortality in survivors of myocardial infarction.