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

Abstract

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

Acute myocardial infarction: predictors of mortality at a public hospital in the city of Fortaleza, Ceará state

“…The findings of our study are in accordance with those usually reported in the literature: Hands et al 37 , comparing the evolution of patients with acute myocardial infarction of the anterior wall with that of patients with acute myocardial infarction of the inferior region, found a greater mortality in those patients with infarction of the anterior wall. Those authors stated that the location of infarction is an important prognostic indicator, independent of its magnitude, which is expressed by the peak in the creatine kinase levels.…”

“…The most frequent impairment of the left ventricular anterior wall and of the right ventricle in group B patients observed on the electrocardiogram is the major cause of the more severe condition of those patients 37,38 . That severity was equivalent to the severity of inferior acute myocardial infarction accompanied by impairment of the right ventricle and to the severity of anteroseptal infarction or the extensive infarction of the anterior wall, and, between them, no significant difference in regard to death exists (P = 0.4199).…”

Sympathetic Drive in Anterior and Inferior Uncomplicated Acute Myocardial Infarction

“…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.…”

Branch Segment Occlusion With Acute Myocardial Infarction is a Risk for Left Ventricular Free Wall Rupture

“…It has been reported previously that LV function and the enzymatic size of infarction are independent predictors of prognosis after AMI. [3][4][5][6] Patients in group B had better preserved cardiac function with a smaller infarct than those in group P. Therefore, it was thought that in-hospital mortality in group B would tend to be lower despite the lower rate of primary PCI.…”