Skip to main content

Predictors and importance of congestive heart failure in patients with acute inferior myocardial infarction

International Journal of Angiology volume 9, pages 171–175 (2000)Cite this article

Abstract

Inferior myocardial infarction (MI) is considered to have a more favorable prognosis than anterior wall MI but includes high risk groups with increased mortality and morbidity. It is well known that congestive heart failure (CHF) complicating acute MI has poor prognosis. In this study we assessed the clinical and prognostic significance of CHF and the predictive value of the baseline demographic and clinical variables for CHF in patients with acute inferior MI. A total of 350 patients with acute inferior MI were included. In group A there were 26 patients (7.4%) with CHF, and in group B there were 324 patients (92.6%) without this complication. Baseline clinical and demographic characteristics and in-hospital complications of the groups were assessed. In group A patients were older (67.6±9.5 vs 53.7±10.9 years, p<0.0001) and there were more female patients (50% vs 15%, p<0.00001) compared to group B. The prevalence of diabetes mellitus (58% vs 16%) and precordial ST segment depression on admission ECG (81% vs 50%) were significantly higher in group A compared to group B (p<0.00001 and p=0.002 consecutively). In group A there was a higher rate of righ ventricular (25% vs 23%), posterior (26% vs 24%) and posterolateral myocardial infarction (19% vs 14%), but the differences were not statistically different. In group A patients had significantly higher rate of second- or third-degree AV block (46% vs 8%, p<0.00001), cardiogenic shock (35% vs 1%, p<0.00001) and mortality (46% vs 3%, p<0.00001) compared to group B. In a multivariate regression analysis diabetes mellitus (p=0.0003) and precordial ST segment depression on admission ECG (p=0.002) were found as the independent predictors of in-hospital CHF in patients with acute inferior MI. CHF and ST segment depression on admission ECG were found as the independent predictors of in-hospital mortality (p<0.00001, p=0.04 consecutively). Patients with CHF complicating acute inferior MI have more unfavorable demographic and clinical characteristics on admission, higher rate of in-hospital complications and mortality. History of diabetes mellitus and precordial ST segment depression on admission ECG have an independent predictive value for CHF in this particular group of patients.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI) (1986) Effectiveness of intraveneous thrombolytic treatment in acute myocardial infarction. Lancet 1:397–402.

    Google Scholar 

  2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group (1988) Randomized trial of intraveneous streptokinase, oral aspirin, both or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 2:349–360.

    Google Scholar 

  3. Kennedy JW, Martin GV, Davis KB, Maynard C, Stadius M, Sheehan FH et al. (1988) The Western Washington intraveneous streptokinase in acute myocardial infarction randomized trial. Circulation 77:345–352.

    Google Scholar 

  4. Berger PB, Ryan TJ (1990) Inferior myocardial infarction: high risk subgroups. Circulation 81:401–411.

    Google Scholar 

  5. Taylor SH (1988) Left ventricular failure complicating acute myocardial infarction-problems and potential of nonthrombolytic therapy. Cardiology 75:67–89.

    Google Scholar 

  6. Meyer J, Erbel R, Rupprecht H-J, von Essen R, Merx W, Effert S (1981) Relation between admission time, haemodynamic measurements and prognosis in acute myocardial infarction. Br Heart J 46:647–656.

    Google Scholar 

  7. Emanuelsson H, Karlson BW, Herlitz J (1994) Characteristics and prognosis of patients with acute myocardial infarction in relation to occurrence of congestive heart failure. Eur Heart J 15:761–768.

    Google Scholar 

  8. Herlitz J, Karlson BW, Bang A (1997) Mode and risk indicators for death during 5 year follow-up of survivors of acute myocardial infarction. An evaluation with particular emphasis on congestive heart failure and age. Coronary Artery Disease 8:455–462.

    Google Scholar 

  9. Lee KL, Woodlief LH, Topol EJ, Weaver WD, Betriu A, Col J et al. for the GUSTO-I Investigators (1995) Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction: results from an international trial of 41 021 patients. Circulation 91:1659–1668.

    Google Scholar 

  10. Multicenter Postinfarction Research Group (1983) Risk stratification and survival after myocardial infarction. N Eng J Med 309:331–336.

    Google Scholar 

  11. Volpi A, DeVita C, Franzosi MG et al. (1993) Determinants of 6-month mortality in survivors of myocardial infarction after thrombolysis: results of GISSI-2 database. Circulation 88:416.

    Google Scholar 

  12. Ratshin RA, Massing GK, James TN (1973) The clinical significance of the location of acute myocardial infarction. In: Myocardial Infarction. Corady E, Swan HJC. (eds). Baltimore: Williams & Wilkins, pg 77.

    Google Scholar 

  13. Kitchin AH, Pocock SJ (1977) Prognosis of patients with acute myocardial infarction admitted to a coronary care unit. 1. Survival in hospital. Br Heart J 39:1163–1166.

    Google Scholar 

  14. Isomaki H, Takala J, Rasanen O (1969) Influence of the site of myocardial infarction on mortality rate. Acta Med Scan 185:227–230.

    Google Scholar 

  15. Thanavaro S, Kleiger RE, Province MA et al. (1982) Effect of infarct location on the in-hospital prognosis of patients with first transmural myocardial infarction. Circulation 66:742–747.

    Google Scholar 

  16. Maisel AS, Gilpin E, Hoit B et al. (1985) Survival after hospital discharge in matched population with inferior myocardial infarction. J Am Coll Cardiol 6:731–736.

    Google Scholar 

  17. Hands ME, Lloyd BL, Robinson JS, deKlerk N, Thompson PL (1986) Prognostic significance of electrocardiographic site of infarction after correction for enzymatic size of infarction. Circulation 77:885–891.

    Google Scholar 

  18. Stone PH, Raabe DS, Jaffe AS, Gustafson N, Muller JE, Turi ZG et al., for the MILIS GROUP (1988) Prognostic significance of location and type of myocardial infarction: independent adverse outcome associated with anterior location. JACC 11:453–463.

    Google Scholar 

  19. Henning R, Lundman R (1975) Swedish Co-operative CCU Study. A study of 2008 patients with acute myocardial infarction from 12 Swedish hospitals with coronary care unit. Part I: A description of the early stage. Acta Med Scan 586:1–64.

    Google Scholar 

  20. Herlitz J, Hjalmarson A, Holmerg S, Swedberg K, Vedin A, Waagstein F, et al (1984) Development of congestive heart failure after treatment with metaprolol in acute myocardial infarction. Br Heart J 15:761–768.

    Google Scholar 

  21. McGovern PG, Folsom AR, Sprafka M, Burke GL, Doliszny KM, Demirovic J et al. (1992) Trends in survival of hospitalized myocardial infarction patients between 1970 and 1985. The Minnesota Heart Survey. Circulation 85:172–179.

    Google Scholar 

  22. Bigger JT, Fleiss JL, Kleiger R, et al. (1984) The relationships among ventricular arrhythmias, left ventricular dysfunction, and mortality in the 2 years after myocardial infarction. Circulation 69:250–258.

    Google Scholar 

  23. Schulze RA, Strauss HW, Pitt B (1977) Sudden death in the year following myocardial infarction: relation to ventricular premature contractions in the late hospital phase and left ventricular ejection fraction. Am J Med 62:192–199.

    Google Scholar 

  24. Hallstrom A, Pratt CM, Greene HL, Huther M, Gottlieb S, DeMaria A, et al. for the Cardiac Arrhythmia Suppression Trial Investigators (1995) Relations between heart failure, ejection fraction, arrhythmia supression and mortality: analysis of the Cardiac Arrhythmia Suppression Trial. J Am Coll Cardiol 25:1250–1257.

    Google Scholar 

  25. Shah PK, Pichler M, Berman DS et al. (1980) Noninvasive identification of a high risk subset of patients with acute inferior myocardial infarction. Am J Cardiol 46:915–921.

    Google Scholar 

  26. Salcedo JR, Baird MG, Chambers RJ, Beanlands DS (1981) Significance of reciprocal S-T segment depression in anterior precordial leads in acute inferior myocardial infarction: concomitant left anterior descending coronary artery disease? Am J Cardiol 48:1003–1008.

    Google Scholar 

  27. Croft CH, Woodward W, Nicod P, et al. (1982) Clinical implications of anterior S-T segment depression in patients with acute inferior myocardial infarction. Am J Cardiol 50:428–436.

    Google Scholar 

  28. Gelmann JS, Saltrups A (1982) Precordial ST segment depression in patients with inferior myocardial infarction: clinical implications. Br Heart J 48:560–565.

    Google Scholar 

  29. Hlatky MA, Califf RM, Lee KL, Pryor DB, Wagner GS, Rosati RA (1985) Prognostic significance of precordial ST-segment depression during inferior acute myocardial infarction. Am J Cardiol 55:325–329.

    Google Scholar 

  30. Lembo NJ, Starling MR, Dell-Italia LJ, Crawford MH, Chaudhuri TK, O'Rourke RA (1986) Clinical and prognostic importance of persistent precordial (V1-V4) electrocardiographic ST segment depression in patients with inferior transmural myocardial infarction. Circulation 74:56–63.

    Google Scholar 

  31. Bates ER, Clemmensen PM, Califf RM, et al. (1990) Precordial ST segment depression predicts a worse prognosis in inferior infarction despite reperfusion therapy. J Am Coll Cardiol 16:1538–1544.

    Google Scholar 

  32. Peterson ED, Hathaway WR, Zabel KM, Pieper KS, Granger CB, Wagner GS et al. (1996) Prognostic significance of precordial ST segment depression during inferior myocardial infarction in the thrombolytic era: results in 16,521 patients. JACC 28:305–312.

    Google Scholar 

  33. Birnhaum Y, Herz I, Sclarovsky S, Zlotikamien B, Chetrit A, Olmer L, et al. (1996) Prognostic significance of precordial ST segment depression in patients with inferior wall myocardial infarction. J Am Coll Cardiol 28:313–318.

    Google Scholar 

  34. Goldberg HL, Borer JS, Jacobstein JG, Kluger J, Scheidt SS, Alonso DR (1981) Anterior ST-segment depression in acute inferior myocardial infarction: indicator of posterolateral infarction. Am J Cardiol 48:1009–1015.

    Google Scholar 

  35. Ong L, Valdellon B, Coromilas J, Brody R, Reiser P, Morrison J (1983) Precordial S-T segment depression in inferior myocardial infarction: evaluation by quantitative thallium-201 scintigraphy and technetium-99m ventriculography. Am J Cardiol 51:743–749.

    Google Scholar 

  36. Gibson RS, Crampton RS, Watson DD, et al. (1982) Precordial ST-segment depression during acute inferior myocardial infarction: clinical, scintigraphic and angiographic correlations. Circulation 66:732–741.

    Google Scholar 

  37. Roubin GS, Shen WF, Nicholson M, Dunn RF, Kelly DT, Harris PJ (1984) Anterolateral ST segment depression in acute inferior myocardial infarction: angiographic and clinical implications. Am Heart J 107:1177–1182.

    Google Scholar 

  38. Nashmith J, Marpole D, Rahal D, Homan J, Stewart S, Sniderman A (1982) Clinical outcomes after inferior myocardial infarction. Ann Intern Med 96:22–26.

    Google Scholar 

  39. Willems JL, Willems RJ, Willems GM, Arnold AER, Van de Werf F, Verstraete M (1990) Significance of initial ST segment elevation and depression for the management of thrombolytic therapy in acute myocardial infarction. Circulation 82:1147–1158.

    Google Scholar 

  40. Lundergan CF, Reiner JS, Deychak YA, et al. for the GUSTO Investigators (1994) Mortality stratification in acute inferior myocardial infarction by surface ECG (abstract). Circulation 90 Suppl I:I-500.

    Google Scholar 

  41. Braat SH, deZwaan C, Brugada P, Coenegracht JM, Wellens HJJ (1984) Right ventricular involvement with acute inferior myocardial infarction identifies high risk of developing atrioventricular nodal conduction disturbances. Am Heart J 107:1183–1187.

    Google Scholar 

  42. Barrillon A, Chaignon M, Guizel L, Berbaux A (1975) Premonitory sign of heart block in acute posterior infarction. Br Heart J 37:2–8.

    Google Scholar 

  43. Nistor-Hemmert D, Ciplea A (1982) The predictive value of V3R-V4R precordial leads in the occurrence of conduction disturbances in acute myocardial infarction (AMI). Physiologie 19:87–90.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Cardiology, University of Istanbul, Istanbul, Turkey

    Rasim Enar M.D., Seçkin Pehlivanoğlu M.D., Işil Uzunhasan M.D., Alev Arat M.D. & Nuran Yazicioğlu M.D.

Authors
  1. Rasim Enar M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seçkin Pehlivanoğlu M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Işil Uzunhasan M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alev Arat M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nuran Yazicioğlu M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Enar, R., Pehlivanoğlu, S., Uzunhasan, I. et al. Predictors and importance of congestive heart failure in patients with acute inferior myocardial infarction. International Journal of Angiology 9, 171–175 (2000). https://doi.org/10.1007/BF01616500

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01616500

Keywords

  • Diabetes Mellitus
  • Myocardial Infarction
  • Congestive Heart Failure
  • Independent Predictor
  • Prognostic Significance