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ACCOMPANYING our investigations into the physiological action of extracts of the suprarenal capsules published ifi preliminary form in the

We assessed the role of physiologic measurements of heart function in predicting mortality after myocardial infarction. Most of the 866 patients enrolled in our multicenter study underwent 24-hour Holter monitoring and determination of the resting radionuclide ventricular ejection fraction before discharge. Univariate analyses showed a progressive increase in cardiac mortality during one year as the ejection fraction fell below 0.40 and as the number of ventricular ectopic depolarizations exceeded one per hour. Only four risk factors among eight prespecified variables were independent predictors of mortality: an ejection fraction below 0.40, ventricular ectopy of 10 or more depolarizations per hour, advanced New York Heart Association functional class before infarction, and rales heard in the upper two thirds of the lung fields while the patient was in the coronary-care unit. Various combinations of these four factors identified five risk subgroups with two-year mortality rates ranging from 3 per cent (no factors) to 60 per cent (all four factors).

SUMMARY We studied the in-hospital prognosis of 1105 patients who had their first transmural myocardial infarction; 611 patients (55.3%) had anterior myocardial infarction (AMI) and 494 (44.7%) had inferior myocardial infarction (IMI). Patients with IMI had a significantly lower in-hospital mortality rate (9.1% vs 15.6%, p = 0.0014) and significantly lower prevalences of congestive heart failure (39.4% vs 47.6%, p = 0.0066), cardiogenic shock (8.7% vs 12.6%, p = 0.0384) and conduction defects (left anterior hemiblock, right bundle branch block and intraventricular conduction defect). The patients with AMI had significantly higher peak enzyme levels, and a greater percentage of them (40.1% vs 25.9%) had SGOT >240 IU/l, whereas more patients with IMI (34.6% vs 27.8%) had SGOT <120 IU/I (p = 0.0001). When the parallel subgroups were compared according to the peak SGOT levels (<120, 120-240, and >240 IU/l, the differences in the mortality and morbidity between the two infarct locations diminished. However, patients with AMI still had a less favorable outcome. Logistic regression analysis demonstrated that both the peak enzyme level and the infarct location had an independent influence on the in-hospital prognosis of patients with first transmural infarction.THE LOCATION of acute myocardial infarction (MI) has a significant influence on the patient's subsequent clinical course. Patients with inferior MI (IMI) have a significantly better prognosis'-9 and less myocardial damage9 10 than those with anterior MI (AMI). Goldberg and associates' concluded that the prognosis of patients was probably related to the extent of myocardial damage rather than to the MI location. By this reasoning, when allowance is made for the extent of myocardial injury or the amount of cardiac enzyme release, patients with MI regardless of the location would be expected to have a similar prognosis.A recent report' demonstrating a worse prognosis of patients with AMI than those with IMI of similar infarct size indicated that the MI location itself may have an independent influence on the outcome of patients with acute MI. However, the finding of similar infarct size in patients with either MI location in this study9 differs from the findings of other reports,9 '0 which showed less myocardial damage associated with IMI. Furthermore, the influence of the enzyme release on the prognosis of patients with these two MI locations has not been fully investigated. Thus, we studied the in-hospital mortality and morbidity of patients with first transmural MI. The patients were stratified according to peak enzyme release to evaluate the independent contribution of MI location to the acute prognosis. All patients were admitted to the CCU for close surveillance and continuous cardiac monitoring for at least 3 days. A standard 12-lead ECG and serum enzyme levels were obtained for at least the first three consecutive days. The upper limit of normal for serum SGOT was 30 IU/l and for LDH was 205 IU/l. Demographic and clinical information was prospectively abstr...