Effect of infarct location on the in-hospital prognosis of patients with first transmural myocardial infarction.

Thanavaro, Samer; Kleiger, Robert E.; Province, Michael A.; Hubert, Jean-Christophe; Miller, John P.; Krone, Ronald J.; Oliver, George

doi:10.1161/01.cir.66.4.742

Cited by 107 publications

(38 citation statements)

References 35 publications

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“…demonstrated a poorer prognosis (both early and late) for patients with anterior than for those with inferior infarction of similar size. However, they found no difference in the extent of infarction with either location of infarction, a finding that differs from other reports.5'6 Thanavaro et al 5 concluded that peak enzyme level and the location of the infarct each have independent influence on in-hospital prognosis of patients with myocardial infarction.…”

mentioning

confidence: 61%

Prognostic significance of electrocardiographic site of infarction after correction for enzymatic size of infarction.

Hands¹,

Lloyd²,

Robinson³

et al. 1986

Circulation

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To assess whether the site of myocardial infarction is an independent prognostic indicator, the outcome of patients with anterior myocardial infarction was compared with that of patients with inferior infarction. A consecutive series of patients who had suffered their first myocardial infarction was analyzed (398 with anterior and 391 with inferior infarction). Patients with anterior myocardial infarction had a higher 1 year mortality than those with inferior infarction (18.3% vs 10.5%, p = .002). When patients were matched for infarct size determined by peak creatine kinase (CK) level expressed as a multiple of the upper limit of normal, those with anterior myocardial infarction tended to have a higher 1 year mortality than those with inferior infarction for all subgroups of peak CK. Early mortality (day 1 to 28 after myocardial infarction) was greater in the anterior than in the inferior myocardial infarction group (10% vs 6.4%, p = .03); this was most significant when peak CK was greater than four times normal (12.4% vs 7.0%, p = .04). Late mortality was also higher in the anterior (8.4% vs 4. 1%, p = .04) than the inferior infarction group and this was most significant when peak CK was less than two times normal (15.2% vs 0%, p = .02) or greater than eight times normal (10.6% vs 4.1%, p = .04). Multivariate analysis with proportional-hazards regression confirmed the prognostic significance of location of infarction independent of peak CK level. Thus, infarct location was found to be a predictor of prognosis that is independent of infarct size based on peak CK levels. Circulation 73, No. 5, 885-891, 1986.! THE PROGNOSIS of patients with anterior myocardial infarction is significantly worse than that of patients with inferior myocardial infarction.'-5 Anterior infarction is associated with more myocardial damage than inferior infarction.5' 6 It remains unclear whether this difference in survival is due to the site or the size of myocardial infarction.Goldberg et al.7 concluded that the poorer prognosis for patients with anterior myocardial infarction was probably related to the extent of myocardial damage rather than the location of the injury. Strauss et al.' demonstrated a poorer prognosis (both early and late) for patients with anterior than for those with inferior infarction of similar size. However, they found no

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mentioning

confidence: 61%

Prognostic significance of electrocardiographic site of infarction after correction for enzymatic size of infarction.

Hands¹,

Lloyd²,

Robinson³

et al. 1986

Circulation

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“…A recent report of 105 patients treated for initial myocardial infarction between 1971 and 1978 found an overall in-hospital mortality rate of 13%, with patients who had an anterior myocardial infarction having a higher mortality rate (15.6%) than did those with inferior infarcts (9.1%). 16 We would anticipate a slightly higher in-hospital mortality rate in our series since patients with previous myocardial infarctions were included, but the rate in our control group was 15%. It is therefore unlikely that better survival in the streptokinase group was due to an excessive mortality rate in the control group.…”

Section: Discussionmentioning

confidence: 89%

Sustained improvement in left ventricular function and mortality by intracoronary streptokinase administration during evolving myocardial infarction.

Smalling¹,

Fuentes²,

Matthews³

et al. 1983

Circulation

140

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One hundred eighty-eight patients with acute myocardial infarction were studied prospectively from August 1980 to September 1982. One hundred thirty-six of these patients were entered into a intracoronary streptokinase study after informed consent was obtained. The remaining 52 patients, who either met exclusion criteria for the study or refused to participate, served as a control group and were treated as those in the study group except that they did not undergo emergency cardiac catheterization. Left ventricular function was determined in both groups by gated radionuclide ejection fraction (EF) on admission to the hospital, at discharge, and 6 months after discharge. With successful reperfusion up to 18 hr after onset of chest pain, mean left ventricular function in the study group improved (EF 39 + 13% on admission and 46 + 12% at discharge; p < .001). Mean EF in control patients and those not achieving reperfusion did not change from admission to discharge. Mean EF at 6 month follow-up was not significantly different than at discharge in the study group or the control group. Total cardiac mortality in the control group was 19% compared with 10% in the study group (p = .06, NS). When patients admitted in pulmonary edema or shock (Killip class III or IV) were excluded from both groups, total cardiac mortality in the study group was significantly lower (4%) compared with in the control group (12.5%, p < .05). The administration of intracoronary streptokinase during evolving myocardial infarction up to 18 hr after onset of chest pain may result in decreased mortality and sustained improvement in left ventricular function. Circulation 68, No. 1, 131-138, 1983. STANDARD CURRENT THERAPY for acute myocardial infarction entails prevention or treatment of complications secondary to evolving myocardial necrosis. Mortality during the first 30 days after acute myocardial infarction has been reported to be between 16% and 30% in large series and no definite decrease in this rate was noted between 1960 and 1975.14 Although there is no universally accepted method for reducing myocardial damage, emergency aortocoronary bypass surgery has been reported to decrease mortalityl'6 in certain patients. Intracoronary streptokinase From the University of Texas Medical School at Houston.

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“…5,8,14,15 These factors have included age, extent of left ventricular dysfunction, infarct size, and development of heart failure. [41][42][43][44] It is notable that most of these factors result in sympathetic activation, 1,2,13 which in turn is believed to lead to an adverse outcome. 1,2,21 In addition, it is known that the increased mortality associated with ant-AMI occurs during the first few hours after the onset of infarction.…”

Section: Graham Et Al Sympathetic Drive and Site Of Infarctionmentioning

confidence: 99%

Sympathetic Drive in Anterior and Inferior Uncomplicated Acute Myocardial Infarction

et al. 2004

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Background-The sympathetic activation that follows acute myocardial infarction (AMI) has been associated with increased morbidity and mortality. Because the prognosis after anterior AMI (ant-AMI) is worse than that after inferior AMI (inf-AMI), we planned to determine whether the magnitude of sympathetic hyperactivity differs between the two. Methods and Results-Thirty-nine patients with uncomplicated AMI, comprising 2 matched groups of 17 patients with ant-AMI, and 22 patients with inf-AMI were examined. Measurements were obtained 2 to 4 days after AMI and compared with 20 normal subjects (NC) who were matched in terms of age and body weight to the AMI groups. Resting muscle sympathetic nerve activity was quantified from multiunit bursts (MSNA) and from single units (s-MSNA). Both groups of AMI patients were matched with regard to hemodynamic variables, left ventricular function, and infarct size. Both groups had greater (at least PϽ0.01) sympathetic nerve activity than NC (60Ϯ4.3 bursts/100 cardiac beats and 68Ϯ4.9 impulses/100 cardiac beats), but the magnitude of sympathetic nerve hyperactivity in ant-AMI (81Ϯ4.0 bursts/100 cardiac beats and 91Ϯ4.9 impulses/100 cardiac beats) was similar (PϾ0.05) to that in inf-AMI (80Ϯ3.2 bursts/100 cardiac beats and 90Ϯ4.0 impulses/100 cardiac beats) Conclusions-Both ant-AMI and inf-AMI resulted primarily in a similar magnitude of sympathetic nerve hyperactivity.These findings suggest that the worse prognosis after ant-AMI compared with after inf-AMI would not be related primarily to the degree of sympathetic hyperactivity.

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Effect of infarct location on the in-hospital prognosis of patients with first transmural myocardial infarction.

Cited by 107 publications

References 35 publications

Prognostic significance of electrocardiographic site of infarction after correction for enzymatic size of infarction.

Prognostic significance of electrocardiographic site of infarction after correction for enzymatic size of infarction.

Sustained improvement in left ventricular function and mortality by intracoronary streptokinase administration during evolving myocardial infarction.

Sympathetic Drive in Anterior and Inferior Uncomplicated Acute Myocardial Infarction

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