Prognostic significance ofelectrocardiogra

To assesswhether thesite ofmyocardial infarction isan independent prognostic indicator, theoutcomeofpatients withanterior myocardial infarction was compared withthatof patients withinferior infarction. Aconsecutive series ofpatients whohadsuffered their first myocardial infarction was analyzed (398withanterior and391withinferior infarction). Patients withanterior myocardial infarction hada higher 1yearmortality thanthose withinferior infarction (18.3% vs 10.5%, p = .002). Whenpatients werematched forinfarct size determined bypeakcreatine kinase (CK)level expressed as a multiple oftheupperlimit ofnormal, those withanterior myocardial infarction tended tohave ahigher 1yearmortality thanthose withinferior infarction forall subgroups ofpeakCK.Early mortality (day1to28after myocardial infarction) was greater intheanterior thanin theinferior myocardial infarction group(10%vs6.4%, p = .03); this was mostsignificant whenpeak CK was greater than four times normal (12.4% vs7.0%, p = .04). Latemortality was also higher inthe anterior (8.4% vs4.1%,p = .04) thantheinferior infarction groupandthis was mostsignificant when peakCK was less than twotimes normal (15.2% vs0%,p = .02) orgreater thaneight times normal (10. 6% vs4.1%, p = .04). Multivariate analysis withproportional-hazards regression confirmed the prognostic significance oflocation ofinfarction independent ofpeakCK level. Thus, infarct location was found tobeapredictor ofprognosis that isindependent ofinfarct size based on peakCK levels. Circulation 73,No.5,885-891, 1986.!