Clinical significance and prognostic importance of left ventricular hypertrophy in non-Q-wave acute myocardial infarction.
Left ventricular (LV) hypertrophy is known to be an independent risk factor for cardiac death, but its significance in non-Q-wave acute myocardial infarction (AMI) has not been assessed previously. In a randomized diltiazem-placebo-controlled therapeutic trial of non-Q-wave AMI confirmed by creatine kinase-MB (CK-MB), 126 of 544 patients (23%) exhibited LV hypertrophy using standard voltage criteria. Compared to patients without LV hypertrophy, patients with LV hypertrophy were significantly older (65 vs 60 years, p less than 0.0001) and had smaller peak adjusted CK levels (490 +/- 376 vs 666 +/- 726 IU/liter, p less than 0.001) than patients without LV hypertrophy. Patients with and without LV hypertrophy did not differ significantly in acute mortality during hospitalization, progression to Q waves, reinfarction by CK-MB criteria or angina associated with transient electrocardiographic changes. Compared with patients without LV hypertrophy, those patients with non-Q-wave AMI and LV hypertrophy had a 2-fold higher incidence of reinfarction (24 vs 12%, p less than 0.005) and death (19 vs 9%, p = 0.044) during the first year of follow-up. Multivariate regression analysis revealed that the relative risk of death and reinfarction during the initial year after AMI was increased by a factor of 1.7 and 2.1 among patients with LV hypertrophy, respectively. It was therefore concluded that, although patients with LV hypertrophy and non-Q-wave AMI have smaller enzymatic infarcts and the same short-term prognosis as do patients without LV hypertrophy, their reinfarction and mortality rates are significantly increased during the first year of follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
Boden
W E
WE
Department of Internal Medicine, Harper Hospital/Detroit Medical Center, Michigan 48201.
Kleiger
R E
RE
Schechtman
K B
KB
Capone
R J
RJ
Schwartz
D J
DJ
Gibson
R S
RS
D000367:Age Factors; D006332:Cardiomegaly / Q000401:mortality*; D002986:Clinical Trials as Topic; D003402:Creatine Kinase / Q000097:blood; D004110:Diltiazem / Q000627:therapeutic use; D004562:Electrocardiography; D006801:Humans; D007527:Isoenzymes; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality*; D011379:Prognosis; D011897:Random Allocation; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors
D007527:Isoenzymes; D003402:Creatine Kinase; D004110:Diltiazem