Which factors are associated with a worse prognosis of myocardial infarction (MI, heart attack)?

Updated: May 07, 2019
  • Author: A Maziar Zafari, MD, PhD, FACC, FAHA; Chief Editor: Eric H Yang, MD  more...
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Answer

Poorer prognosis is associated with the following factors:

  • Advanced age

  • Diabetes mellitus

  • Previous vascular disease (eg, cerebrovascular disease or peripheral vascular disease)

  • Elevated thrombolysis in MI (TIMI) risk score for unstable angina/non–ST elevation acute coronary syndrome (NSTE-ACS) (TIMI risk score includes 7 factors: age ≥65 y, ≥3 risk factors for cardiac disease, previous coronary disease, ST-segment deviation ≥0.5 mm, ≥2 episodes of angina in last 24 hours, aspirin use within prior week, and elevated cardiac enzyme levels) [1, 3, 33]

  • Delayed or unsuccessful reperfusion

  • Poorly preserved left ventricular function (the strongest predictor of outcome)

  • Evidence of congestive heart failure (Killip classification ≥II) [34] or frank pulmonary edema (Killip classification ≥III) [35]

  • Elevated B-type natriuretic peptide (BNP) levels [36, 37, 38]

  • Elevated high sensitive C-reactive protein (hs-CRP), a nonspecific inflammatory marker [39]

  • Involvement of electrocardiograph (ECG) lead aVR [40, 41]

  • Depression


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