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Mortality, arrhythmias and pump failure in acute myocardial infarction in relation to estimated infarct size
Insights
Maximum creatine kinase (CK) levels combined with age and prior heart attack history effectively identify high-risk acute myocardial infarction (AMI) patients. This stratification aids in predicting mortality and identifying those needing closer monitoring.
Area of Science:
- Cardiology
- Biochemistry
Background:
- Acute myocardial infarction (AMI) poses significant mortality risks.
- Accurate risk stratification is crucial for managing AMI patients.
- Serum creatine kinase (S-CK) is a biomarker for myocardial damage.
Purpose of the Study:
- To evaluate the predictive value of maximum S-CK levels and infarct size for mortality in AMI patients.
- To determine if combining these biomarkers with patient history improves risk stratification.
Main Methods:
- Serial S-CK estimations in 194 consecutive AMI patients.
- Calculation of infarct size in a subset of patients.
- Analysis of mortality rates based on maximum S-CK, infarct size, age, and history of previous AMI.
Main Results:
- Maximum S-CK and infarct size alone did not reliably predict mortality.
- Combining maximum S-CK or infarct size with age and prior AMI history identified distinct high-risk (46% and 43% mortality) and low-risk (6% and 3% mortality) subgroups.
- High-risk groups showed increased incidence of shock and severe left heart failure.
Conclusions:
- Age and prior AMI history are critical factors when interpreting S-CK levels and infarct size for risk stratification in AMI.
- This combined approach enhances the identification of high-risk patients requiring intensive management.
Abstract:
Serial estimations of total serum creatine kinase (S-CK) were made in 194 consecutive patients with acute myocardial infarction (AMI). By itself, the maximum CK value could not separate patients in terms of high and low mortality but when the maximum CK value was related to age for patients with and without a history of previous AMI, two subgroups became apparent, one with 46% mortality (high-risk group) and another with 6% (low-risk group) during the hospital stay plus the next 90 days. In 114 of the patients, infarct size could be calculated. A good correlation was found between maximum CK and calculated infarct size (r = 0.93). Calculated infarct size alone could not distinguish between high and low mortality but when it was related to age for patients with and without a history of previous AMI, two subgroups emerged, one with 43% mortality and another with 3% during the hospital stay plus the next 90 days. The incidence of ventricular tachycardia during the stay in the Coronary Care Unit did not differ between the two risk groups separated either by maximum CK value or calculated infarct size. However, the incidence of shock and severe left heart failure during the acute phase was higher in the high-risk groups.