Anterior and posterior wall infarction of the heart: A statistical comparison based on autopsy findings

Abstract

Statistical analysis of 514 cases of anterior and posterior wall infarcts of the heart reveals that the chief pathologic features of both types are similar. Anterior apical infarcts often extend to the adjacent endocardium and epicardium, and thus give rise to mural thrombus formation and pericarditis more frequently than do posterior basal ones. The differences in incidence of these complications in the two types of infarcts are great enough to be reasonably conclusive ones. Differences in incidence of other characteristics are also noted but these are not of sufficient magnitude to exclude the possibility of chance variation. Some of these unproved differences would be of clinical importance if they could be confirmed by other analyses. They will, therefore, be summarized briefly: (1) The ratio of anterior wall to posterior wall infarction may increase progressively with advancing age. (2) Acute posterior wall infarction may have a slightly higher mortality rate than acute anterior wall infarction despite the lower incidence of mural thrombosis and pericarditis in the former. (3) Superimposed new infarcts in areas of old infarction may be found more frequently in the anterior wall. (4) Anterior wall infarcts in men tend to be larger than posterior wall lesions; the reverse may be true in women. (5) Healed posterior wall infarcts in women may be more often clinically manifest than other healed infarcts. (6) Thrombi in the right ventricle and both auricular appendages, as well as in the left ventricle, may less frequently complicate posterior than anterior wall infarction. (7) Pre-existing hypertension may persist more frequently in acute posterior wall than in acute anterior wall infarction and may be a poor prognostic sign. (8) The coincidence of diabetes may be particularly high in fatal acute posterior wall infarction.