Myocardial infarction: anterior wall infarcts had a worse prognosis.

Clinical bottom line (level 1b)

  1. In patients with first Q-wave infarct, an anterior location was related to a worse in-hospital mortality (NNF = 19 for unknown) .
  2. Anterior wall infarct had no clear effect on 5 year mortality.
Behar et al: American Journal of Cardiology 1993; 72: 1366-1370
Expires March 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: multicentre Israeli study

3653 patients (aged mean 62y (SD 11y), 74% male) first acute Q-wave myocardial infarction (diagnosed by 2/3 symptoms, ECG changes and enzyme changes)

Excluded if
  • lateral or posterior infarct location (199 cases)
  • undetermined infarct location (129 cases)



    • Factors studied:
  • age; sex; prior angina; diabetes; radiographic pulmonary oedema; Killip class >II at admission; developing heart failure; VT/VF; cardiac enzymes >400% normal
  • anterior wall infarct


  • standard treatment for 1981-83 and some randomised to nifedipine/placebo (SPRINT trial)

    Multivariate analysis was used to adjust for confounding factors.

    99% of hospital survivors (range 4.5 to 7.0 y) followed for 5.5y mean
    Outcomes studied:
  • in hospital mortality
  • 5 year mortality (hospital survivors only)

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    in hospital mortality 5.5y mean 545/2653 20.5%
    (19.0% to 22.1%)
    5 year mortality 5.5y mean 687/2653 25.9%
    (24.2% to 27.6%)

    prognostic factor for
    in hospital mortality     		time to outcome control rate (%) adjusted OR
    (90% CI)    		 NNF+
    (95% CI)
    anterior wall infarct ? 193/1724
    (11%)     		1.57
    (1.26 to 1.96)     		19
    (12 to 40)

    prognostic factor for
    5 year mortality     		time to outcome control rate (%) unadjusted OR
    (90% CI)
    ? 1.12
    (0.99 to 1.27)

    Comments

    1. Exclusion of a small number of undetermined and posteriolateral infarcts is unlikely to markedly alter the study results.

    Citation

    1. Behar S, Rabinowitz B, Zion M, et al: Immediate and long-term prognostic significance of a first anterior versus inferior wall Q-wave acute myocardial infarction. American Journal of Cardiology 1993; 72: 1366-1370
    Contributor: Bob Phillips and Clare Wotton, November 1999
    Reviewer:

    Clinical Question.
    Patient patients with first myocardial infarction
    Intervention or Exposure anterior vs inferior wall infarct
    Outcome mortality