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Myocardial Infarct Extension: Occurrence, Outcome, and Risk Factors in the Multicenter Investigation of Limitation of Infarct Size

JAMES E. MULLER, M.D.; ROBERT E. RUDE, M.D.; EUGENE BRAUNWALD, M.D.; TYLER D. HARTWELL, Ph.D.; ROBERT ROBERTS, M.D.; BURTON E. SOBEL, M.D.; CYNTHIA RITTER; CORETTE B. PARKER, M.S.; ALLAN S. JAFFE, M.D.; PETER H. STONE, M.D.; DANIEL S. RAABE Jr., M.D.; JAMES T. WILLERSON, M.D.; and THOMAS ROBERTSON, M.D.
[+] Article and Author Information

Grant Support: by N01-HV-2940 and 7-2979 from the National Heart, Lung, and Blood Institute, National Institutes of Health, and U. S. Department of Health and Human Services to the Multicenter Investigation of the Limitation of Infarct Size (MILIS) Group.

▸Requests for reprints should be addressed to James E. Muller, M.D.; Harvard Medical School, 164 Longwood Avenue, Boston, MA 02115.


THE MILIS STUDY GROUP; Boston, Massachusetts


© 1988 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1988;108(1):1-6. doi:10.7326/0003-4819-108-1-1
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The occurrence, outcome, and predictors of myocardial infarct extension were determined in 848 patients with acute myocardial infarction. An increase in the level of plasma MB creatine kinase activity was used to detect extension, which occurred in 71 of 848 patients (8.4%). For these patients, hospital mortality was more than four times higher than for those without extension (30% versus 7%, P < 0.01). However, for patients surviving the initial hospitalization, there was no significant difference in mortality during the following year (12% compared with 9%). Multivariable analyses indicated that extension was more likely to occur in patients with recurrent ischemic pain during the second hospital day, a history of previous myocardial infarction, and ST segment depression on the admission electrocardiogram. The occurrence of extension in patients with two of these risk factors was more than twice that of patients without any of the risk factors (15.1% compared with 5.8%). Patients with these risk factors should be considered for early coronary angiography and possible intervention to prevent infarct extension and its sequellae.

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