A population-based study of factors associated with the prognosis of acute myocardial infarction

The impact of several factors on in-hospital prognosis (presence of congestive heart failure, shock, transmural MI) is consistent with the suggestion that during the acute phase, survival appears to be directly related to the extent of myocardial necrosis and clinical severity of MI. It is therefore apparent that limitation of the size and extent of infarction and preservation of existing myocardium are interventions that should be pursued diligently. Recent physiologic and pharmacologic approaches to this problem appear feasible and promising. On the other hand, factors related to postdischarge prognosis appear to be related both to cardiac dysfunction (e.g., congestive hear failure) and to underlying coronary artery disease (e.g., history of angina pectoris). This is to be expected, since after the acutely infarcted area heals, subsequent survival seems to be dictated both by the cumulative extent of myocardial damage and by the extent and progression of the atherosclerotic lesions. The results of this study support the identification by simple diagnostic methods of several subgroups of patients with acute MI who are at greater risk of dying both in the hospital and after discharge. Given the encouraging results of recent secondary prevention trials examining the long-term survival of MI patient in relation to either antiplatelet agents such as sulfinpyrazone or coronary artery bypass surgery, such efforts, if proven to be efficacious, might be considered in these high-risk patients in order to improve their long-term outlook.