International Journal of Cardiology 90 (2003) 189–196 www.elsevier.com / locate / ijcard Acute myocardial infarction: differing preinfarction and clinical features according to infarct site and gender ˇ * ´ ´ ´ Viktor Culic, Dinko Miric , Ivana Jukic ˇ´ Department of Medicine, Division of Cardiology, Clinical Hospital Split, Spinciceva 1, 21000 Split, Croatia Received 4 March 2002; received in revised form 26 September 2002; accepted 23 October 2002 Abstract While differences between anterior and inferior acute myocardial infarction have been observed, clinical features of lateral infarction are poorly investigated. However, the impact of gender on clinical course and prognosis after myocardial infarction is not fully understood. Electrocardiographically determined infarct site, demographic and clinical variables were prospectively recorded for 1623 consecutive patients admitted to Clinical Hospital Split between 1990 and 1994 due to a first Q-wave acute myocardial infarction. 26 212 Anterior infarctions were correlated with a higher prevalence of diabetes ( P54310 ) or pulmonary venous congestion ( P52310 ); inferior infarctions were correlated with a lower prevalence of hypertension ( P50.001), hypercholesterolemia ( P50.02) or diabetes 25 ( P510 ), and a higher prevalence of smoking ( P50.001); lateral infarctions were characterized by a smaller infarction size and lower prevalence of pulmonary congestion (P50.002). Among men under the age of 50 with inferior infarction there were 90% smokers, which 25 was significantly more than among their gender (P50.005) or infarct site ( P52310 ) counterparts. After adjustment for age and other confounding factors, the prevalence of inferior infarction was higher in men ( P50.002). Increased age (P50.002), female gender 25 ( P50.0006), anterior site ( P510 ), diabetes (P50.0003), greater creatine kinase-MB fraction level ( P50.001) and pulmonary 26 congestion ( P59310 ) were independent predictors of an adverse hospital outcome. Each site of acute myocardial infarction has relatively specific preinfarction and clinical features. Our results suggest a greater importance of vasoconstriction in the pathophysiology of inferior infarction, especially in young male smokers, and greater importance of advanced atherosclerotic process in occurrence of anterior infarction.  2003 Elsevier Ireland Ltd. All rights reserved. Keywords: Gender; Myocardial infarction; Risk factors; Site; Vasoconstriction 1. Introduction atherogenesis, occurrence of onset of myocardial infarction and the improvement in pre- and post- Pathophysiology and clinical manifestations of infarction treatment. acute myocardial infarction in various subgroups of It has been suggested that infarction site and patients is an area of great research interest. The gender may be significant determinants of clinical rationale is that an understanding of the natural course and outcome after acute myocardial infarction. history in different population subgroups may help in Typical external triggers, left ventricular dysfunction, better understanding of the whole process of in-hospital complications and mortality rates differ between patients with anterior and inferior infarction [1–10]. A small body of evidence describes the *Corresponding author. Tel.: 1385-21-556-518; fax: 1385-21-365- clinical features of lateral infarction [5]. Furthermore, 619. ´ E-mail address: viktor.culic@st.hinet.hr (D. Miric). men and women with acute myocardial infarction 0167-5273 / 03 / $ – see front matter  2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016 / S0167-5273(02)00563-6