Prognosis Of Acute Myocardial Infarction Research Articles

Study of C-reactive protein in patients with acute myocardial infarction attending tertiary care teaching hospital in Saurashtra region of Gujarat, India

Background: Acute Myocardial Infarction is a major contributor to morbidity and mortality globally. A growing body of evidence supports the concept of local and systemic inflammation playing a critical pathophysiologic role in progression of atherothrombosis and occurrence of infarction. Objectives of the study were to assess the role of serum C-reactive protein (CRP) levels in patients with first acute myocardial infarction attending tertiary care teaching hospital. Methods: A cross sectional study was carried out from October 2009 to September 2010 in tertiary care teaching institute in Saurashtra region, Gujarat, India. A total of 50 patients admitted to intensive cardiac care unit with a diagnosis of acute myocardial infarction were enrolled. Serum CRP levels were sent at 6 hrs to 36 hrs of chest pain. Patients were assessed for early complications as well as left ventricular function on Echocardiography. Results were analysed using appropriate statistical methods. Results: In this study, the mean age of presentation of acute myocardial infarction was 52.7 years which is a decade younger than in previous studies. CRP levels were found to be elevated in 79.4% of patients with anterior wall myocardial infarction. Raised CRP levels were associated with greater incidence of (50%) early complications after acute myocardial infarction. Raised CRP levels were also associated with a LVEF<40% in 32.5% cases implying a poorer prognosis. Conclusions: Present study concluded that raised CRP levels correlated with poorer prognosis in acute myocardial infarction. And can be used as a simple tool for prognostic stratification in acute myocardial infarction.

Acute hyperglycemia abolishes cardioprotection by remote ischemic perconditioning.

BackgroundRemote ischemic perconditioning (RIPerC) has a promising therapeutic insight to improve the prognosis of acute myocardial infarction. Chronic comorbidities such as diabetes are known to interfere with conditioning interventions by modulating cardioprotective signaling pathways, such as e.g., mTOR pathway and autophagy. However, the effect of acute hyperglycemia on RIPerC has not been studied so far. Therefore, here we investigated the effect of acute hyperglycemia on cardioprotection by RIPerC.MethodsWistar rats were divided into normoglycemic (NG) and acute hyperglycemic (AHG) groups. Acute hyperglycemia was induced by glucose infusion to maintain a serum glucose concentration of 15–20 mM throughout the experimental protocol. NG rats received mannitol infusion of an equal osmolarity. Both groups were subdivided into an ischemic (Isch) and a RIPerC group. Each group underwent reversible occlusion of the left anterior descending coronary artery (LAD) for 40 min in the presence or absence of acute hyperglycemia. After the 10-min LAD occlusion, RIPerC was induced by 3 cycles of 5-min unilateral femoral artery and vein occlusion and 5-min reperfusion. After 120 min of reperfusion, infarct size was measured by triphenyltetrazolium chloride staining. To study underlying signaling mechanisms, hearts were harvested for immunoblotting after 35 min in both the NG and AHG groups.ResultsInfarct size was significantly reduced by RIPerC in NG, but not in the AHG group (NG + Isch: 46.27 ± 5.31 % vs. NG + RIPerC: 24.65 ± 7.45 %, p < 0.05; AHG + Isch: 54.19 ± 4.07 % vs. 52.76 ± 3.80 %). Acute hyperglycemia per se did not influence infarct size, but significantly increased the incidence and duration of arrhythmias. Acute hyperglycemia activated mechanistic target of rapamycine (mTOR) pathway, as it significantly increased the phosphorylation of mTOR and S6 proteins and the phosphorylation of AKT. In spite of a decreased LC3II/LC3I ratio, other markers of autophagy, such as ATG7, ULK1 phopsphorylation, Beclin 1 and SQSTM1/p62, were not modulated by acute hyperglycemia. Furthermore, acute hyperglycemia significantly elevated nitrative stress in the heart (0.87 ± 0.01 vs. 0.50 ± 0.04 µg 3-nitrotyrosine/mg protein, p < 0.05).ConclusionsThis is the first demonstration that acute hypreglycemia deteriorates cardioprotection by RIPerC. The mechanism of this phenomenon may involve an acute hyperglycemia-induced increase in nitrative stress and activation of the mTOR pathway.

Glycaemic status in patients of acute myocardial infarction: A detailed analysis

AimsDiabetes mellitus (DM) is considered to be one of the important risk factors for cardiac diseases. Frank diabetes is usually preceded by long term abnormality in glucose homeostasis which is called pre-diabetes. The hypothesis that diabetic patients have greater risk and worse prognosis of Acute Myocardial Infarction (AMI) than pre-diabetics is controversial. Considering that India has been declared as a diabetic capital of the world, the study aimed to assess the load of pre diabetics, diabetics and non-diabetics landing in myocardial infarction. Materials and methodsThe study consisted of through physiological and biochemical evaluation of 200 patients of newly diagnosed AMI and evaluating the load of non-diabetics, pre-diabetics and diabetics among them. ResultIt was found that the total non-diabetic population (normoglycaemic and pre-diabetic) formed the bulk of AMI patient (69%) in our study. The degree of biochemical alterations seen among the three groups suggests that abnormal glucose homeostasis is not the sole determinant of the severity of AMI. The study data also suggests that glycaemic status, which poses a risk for AMI, differs in male and female individuals. Males even with normal glucose level are at increased risk to develop MI. ConclusionThe study concludes that both males and females with their blood glucose in pre-diabetic range are seen to be vulnerable to develop AMI. Thus all individuals irrespective of their glycaemic status around the age of forty should be screened and individuals with fasting sugar in pre-diabetic range should take extra precaution in terms of healthy diet, life style and regular check up

Correlation of plasma catestatin level and the prognosis of patients with acute myocardial infarction.

Catestatin is a peptide which is a potent inhibitor of catecholamine secretion and played essential functions in the cardiovascular system. Previous research found that dramatic changes of catestatin were associated with hemodynamics in acute myocardial infarction (AMI) during the first week after the AMI symptoms onset, but whether catestatin is also involved in the pathophysiological progression after AMI and then a predictor for outcomes is not clear. The aim of this study is to determine the correlation of plasma catestatin levels at different time points and the prognosis of AMI. 100 participants recruited were all patients with AMI, all of who received successful primary percutaneous coronary intervention (PCI) within 12h from the AMI symptom onset in our center; the concentrations of plasma catestatin were evaluated from blood samples of those 100 participants. Subsequent 65 months' follow-up was performed after discharging to evaluate cardiac adverse events and the association between catestatin levels and prognosis of AMI was examined. We confirmed the dramatic change of catestatin concentrations in the first week of AMI, and the levels of catestatin on D3 were much higher in adverse events group than those in non-adverse events group (p<0.0001), but the ratio of D7/D3 was significantly lower. In addition, the Kaplan-Meier analysis showed that the groups in which the levels on D3 were higher (p<0.0001) and the ratios of D7/D3 were lower (p<0.0001), patients trended to be more susceptive to adverse events after AMI. Furthermore, according to the analysis, we surmised catestatin level on D3 as an appropriate predictor for outcomes in patients with AMI with good specificity as well as sensitivity. All of the evidence confirmed that catestatin plays an important role in the progress of AMI, and may act as a promising target for prognostic prediction.

Characteristics and prognosis of acute myocardial infarction by discharge diagnosis: the Reasons for Geographic and Racial Differences in Stroke study

PurposeTo compare the characteristics and prognosis of acute myocardial infarctions (AMIs) that were not the primary reason for hospitalization, and thus not primary discharge diagnosis, to AMIs that were the primary reason for hospitalization. MethodsPrimary discharge diagnoses for Reasons for Geographic and Racial Differences in Stroke study participants (black and white men and women age ≥45 years) with adjudicated AMIs were categorized as “AMI” or “other”. Cox models were used to compare mortality up to 5 years post-AMI between primary discharge diagnoses of AMI and other. ResultsOf 871 AMIs, primary discharge diagnosis was not AMI in 550 (63%). When primary discharge diagnosis was not AMI, average troponin elevations were smaller and heart failure was more common. Adjusted for participant and hospitalization characteristics, all-cause, coronary heart disease, and cardiovascular disease mortality after AMI were similar between groups (hazard ratios [95% confidence intervals]: 1.08 [0.80–1.47]; 1.29 [0.76–2.18]; and 0.86 [0.58–1.27], respectively). ConclusionsStudies limited to individuals with primary discharge diagnosis of AMI may underestimate the burden of AMI and exclude a group with elevated risk of all-cause, coronary heart disease, and cardiovascular disease mortality.

Association of Serum Electrolytes and Urea Levels with Cardiac Markers in Acute Myocardial Infarction

Background: The alterations (increase or decrease) of intracellular and extracellular enzymes or components in developing phase of disease are called markers. Variations in biochemical markers like Cardiac Troponins-I (cTnI), Creatine kinase (CK) and its isoform Creatine kinase-MB (CK-MB) may correlate with the extent of myocardial damage in Acute Myocardial Infarction (AMI). Association of serum electrolytes and urea levels were undertaken in this study as adjunctive parameters along with cardiac markers, which probably helps in better prognosis of AMI. Materials and Methods: 120 subjects were included in this study and divided equally as study and control groups. Estimation of cTnI, CK, CK-MB, Serum sodium, potassium, chloride and urea were done in all the participants. Data were compared by using student `t’ test and chi-square test (SPSS version 17.0). Results: There were statistically significant decreased levels of serum sodium (p

Impact of Admission Anemia on Coronary Microcirculation and Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

Microvascular dysfunction after primary percutaneous coronary intervention (PCI) augments myocardial damage and prognosis in acute myocardial infarction. However, the relationship between baseline anemia and coronary microcirculation in patients with ST-segment elevation myocardial infarction (STEMI) remains unclear. We performed primary PCI in 337 consecutive patients with STEMI. Anemia was defined as a hemoglobin level < 13 g/dL in men and < 12 g/dL in women. Admission anemia was present in 17.5% of the patients enrolled. Data on epicardial coronary flow, STsegment resolution (STR) on electrocardiography, myocardial injury, and the incidence of adverse cardiac events defined as cardiac death or hospitalization for congestive heart failure were analyzed. The median follow-up period was 54.8 months. Despite comparable epicardial coronary flow, the rate of STR ≥ 50% was lower in anemic patients compared with non-anemic patients (55.9% versus 71.2%, P = 0.02). On multivariate logistic regression analysis, baseline anemia was an independent negative predictor of STR ≥ 50% (odds ratio, 0.53; 95% confidence interval: 0.31-0.92, P = 0.03). Moreover, anemic patients had higher maximum creatine kinase levels normalized for body surface area (2,215 ± 1,318 IU/L/m(2) versus 1,797 ± 1,199 IU/L/m(2), P = 0.047). Anemia remained an independent significant predictor of adverse events on multivariate Cox proportional hazard analysis (hazard ratio, 2.34; 95% confidence interval: 1.01-5.64, P = 0.048). In conclusion, admission anemia was related to microcirculatory dysfunction and poor prognosis in patients with STEMI. The decreased oxygen delivery might exacerbate microvascular function.

Study on correlation of obesity with short-term prognosis in acute myocardial infarction

Study on correlation of obesity with short-term prognosis in acute myocardial infarction

Chronic total occlusion in a non-infarct-related coronary artery exacerbates prognosis in acute myocardial infarction: A Japanese single-center retrospective study

Chronic total occlusion in a non-infarct-related coronary artery exacerbates prognosis in acute myocardial infarction: A Japanese single-center retrospective study

Relationship between red cell distribution width and prognosis in acute myocardial infarction

Relationship between red cell distribution width and prognosis in acute myocardial infarction

The CHA2DS2VASc score can be used to stratify the prognosis of acute myocardial infarction patients irrespective of presence of atrial fibrillation

BackgroundThe CHA2DS2VASc score has been used to evaluate the risk of thromboembolic events in atrial fibrillation. However, because all the components of CHA2DS2VASc are important cardiovascular risk factors, we decided to evaluate the effectiveness of CHA2DS2VASc score as a long-term predictor for prognosis in acute myocardial infarction (AMI) patients. MethodsWe enrolled 15,681 AMI patients for the Korean Working Group in Acute Myocardial Infarction (KORMI) consecutively and analyzed retrospectively. We divided the all the patients into four groups according to CHADS2VASc score (Group I: 0–1, n=3317; Group II: 2–3, n=6794; Group III: 4–5, n=4457; Group IV: 6–9, n=1113). The cardiac event was defined as the sum of all-cause mortality and recurrence of myocardial infarction. ResultsAs the risk score increased, the incidence of cardiac events was higher at 1, 6, 12, and 24 months. The cardiac event-free survival rate was lower as the risk score increased (Group I vs Group II, p<0.001; Group II vs Group III, p<0.001; Group III vs Group IV, p=0.037). After adjusting confounding variables, the Cox-regression multivariate analysis showed that the CHA2DS2VASc score was an independent predictor for the long-term prognosis in total AMI patients (p<0.001, hazard ratio=1.414 per scale). ConclusionThe AMI patients with higher CHA2DS2VASc score had worse cardiovascular outcome. Therefore, CHADS2VASc score can be used to stratify AMI patients according to long-term prognosis irrespective of presence of atrial fibrillation.

Acute myocardial infarction in Scottish military veterans: a retrospective cohort study of 57,000 veterans and 173,000 matched nonveterans.

Few studies of veterans have examined cardiovascular disease as the primary outcome, other than in relation to specific conflicts or hazards. To assess the long-term risk and prognosis of acute myocardial infarction (AMI) in United Kingdom veterans from a broad range of military backgrounds and experience, we conducted a retrospective cohort study of 57,000 veterans resident in Scotland and 173,000 civilians matched on age, sex, and area of residence. Cox proportional hazards models were used to compare the risks of fatal/nonfatal AMI overall, by sex, and by year of birth, adjusting for the potentially confounding effect of socioeconomic status, and to compare rates of case-fatality following AMI at 30-day, 1-year, and 5-year follow-up. Over a mean follow-up period of 29 years between 1981 and 2012, a total of 2,106 (3.8%) veterans experienced an AMI as compared with 5,261 (3.1%) nonveterans (hazard ratio = 1.22, 95% confidence interval: 1.16, 1.29; P < 0.001). There was an increased risk of AMI among veterans born in 1945-1959 but not among those born from 1960 onward. Case-fatality was lower among veterans at 30-day, 1-year, and 5-year follow-up. We conclude that health behaviors such as smoking may have increased the risk of AMI in older veterans but that younger veterans have benefited from in-service health promotion initiatives.

Sleep impairment and prognosis of acute myocardial infarction: a prospective cohort study.

Impaired sleep is an established risk factor for the development of cardiovascular disease, whereas less is known about how impaired sleep affects cardiovascular prognosis. The aim of this study is to determine how different aspects of impaired sleep affect the risk of case fatality and subsequent cardiovascular events following first-time acute myocardial infarction (AMI). Prospective cohort study. The Stockholm Heart Epidemiology Program, Sweden. There were 2,246 first-time AMI cases. Sleep impairment was assessed by the Karolinska Sleep Questionnaire, which covers various indices of impaired sleep: disturbed sleep, impaired awakening, daytime sleepiness, and nightmares. Case fatality, defined as death within 28 days of initial AMI, and new cardiovascular events within up to 10 y of follow-up were identified through national registries. In women, disturbed sleep showed a consistently higher risk of long-term cardiovascular events: AMI (hazard ratio [HR] = 1.69; 95% confidence interval [CI] 0.95-3.00), stroke (HR = 2.61; 95% CI: 1.19-5.76), and heart failure (HR = 2.43; 95% CI: 1.18-4.97), whereas no clear effect of impaired sleep on case fatality was found in women. In men, a strong effect on case fatality (odds ratio = 3.27; 95% CI: 1.76-6.06) was observed in regard to impaired awakening; however, no consistent effect of impaired sleep was seen on long-term cardiovascular prognosis. Results suggest sex-specific effects of impaired sleep that differ by short- and long-term prognosis. Sleep complaints are frequent, easily recognizable, and potentially manageable. Evaluation of sleep complaints may, even if they represent prognostic markers rather than risk factors, provide additional information in clinical risk assessment that could benefit secondary cardiovascular prevention.

Clinical characteristics of young patients with acute myocardial infarction

To analyze the clinical characteristics of young patients with acute myocardial infarction (AMI), discuss the key points of health education in young patients with AMI, enhance the understanding of patients, and improve the prognosis of AMI in the young patients. The patients were chosen in Xiangya Hospital from September 2012 to September 2013. We consulted the medical records, analyzed the clinical characteristics and results of coronary angiogram in young patients (age≤45), and compared with old patients (age≥60). There were 69 young patients with AMI, about 14.2% of all the patients with AMI. Of the 69 young patients, 59 were male (85.5%) and 10 were female (14.5%). Compared with the old patients, the percentages of smoking, drinking, hyperlipidemia and overweight were much higher; the percentages of hypertension and diabetes were much lower in young patients. The coronary angiogram showed that the constituent ratios of insignificant disease and single-vessel disease in the young patients were higher than those in the old patients; the constituent ratios of doublevessel disease and triple-vessel disease in the young patients were lower than those in the old patients. The clinical characteristics of young patients with AMI are different from the old patients. Health education should be conducted in the youth, and new diet and lifestyle should be advocated.

Hs-C-reactive protein as an indicator for prognosis in acute myocardial infarction

Aims and objectives: The objective of this study is to find the serum high sensitivity-C-reactive protein (hs-CRP) in acute myocardial infarction patients at the time of admission and their association with in - hospital mortality and morbidity. Materials and Methods: A total of 50 patients of acute myocardial patients followed-up for 7 days in hospital with admission of serum hs-CRP levels. Slide agglutination was used to find the serum hs-CRP levels for qualitative and serial dilution method to carry out the semi-quantitative titration. Results: Among 50 Acute myocardial infarction (AMI) patients, 45 patients had an elevated hs-CRP and five patients had minimal or lower level of hs-CRP on the time of admission. On follow-up for 7 days, 35 out of 45 who had elevated hs-C-CRP developed vascular complications such as left ventricular failure, cardiogenic shock, ventricular ectopy, atrio-ventricular block etc. A total of 5 patients who had a minimal or low level of hs-CRP at the time of admission didn't develop any kind of complication during their hospital stay. Conclusion: Higher the serum hs-CRP levels at the time of admission in patients with AMI greater the patients prone to develop a complication during their hospital stay.

Can speckle-tracking imaging improve the reliability of echocardiographic parameters for outcome evaluation in clinical trials?

This editorial refers to ‘Early diastolic strain rate in relation to systolic and diastolic function and prognosis in acute myocardial infarction: a two-dimensional speckle-tracking study’[†][1], by M. Ersboll et al. , on page 648 Echocardiography has been used for the assessment of left ventricular (LV) structure and function over almost three decades, and it is the de facto clinical standard for two-dimensional (2D) quantification of LV dimensions, and systolic and diastolic function. In agreement with this, echocardiography is also a commonly used imaging modality in the management of patients with acute myocardial infarction. Because of low costs, easy applicability, and wide availability, echocardiography is useful not only for establishing the diagnosis, site, and magnitude of a myocardial infarction, and its mechanical complications, but also for follow-up studies. In particular, it is valuable for assessment of prognosis and risk stratification. Consequently, the majority of clinical trials have applied dimensions or 2D-derived volumes including LV ejection fraction (EF) as primary or secondary endpoints.1 Several prognostic parameters can be derived from commonly used and from more sophisticated echocardiographic approaches, as listed in Table 1 . View this table: Table 1 Echocardiographic parameters related to prognosis after myocardial infarction However, a major disadvantage of using 2D echocardiography measurement as an endpoint is that it relies to a great extent on vendor skills and therefore is characterized by a relatively high interobserver and test–re-test variability.2,3 Whereas interobserver variability … [1]: #fn-2

Troponin T is a strong predictor of mortality in hip fracture patients

Background: The aim of this prospective cohort study was to assess the prognosis of acute myocardial infarction in a series of consecutive hip fracture patients treated surgically. Methods: A consecutive cohort of patients (n=200, 68 men) referred to un-elective surgical correction of hip fracture was studied. In addition to clinical evaluation, troponin T (TnT), and ECG were assessed on admission, before operation and on 1st and 2nd post-operative days. The patients were followed at 30 days, 1 year and 2 years. Results: The age of the patients ranged from 32 to 98 years (mean age 80.8 years). 65 patients (33%) had a history of coronary artery disease. And 28 (14%) suffered from heart failure. A significant rise in TnT as a sign of myocardial infarction was observed in 71 patients (36%), and 36 (51%) of them had an elevation of TnT already before surgery. 23 (32%) patients had an elevated level of TnT already on admission to hospital, and 35 (49%) developed a TnT elevation postoperatively. Majority of patients with elevated TnT level were asymptomatic. TnT elevations were more common in men, elderly patients, and patients with a history of cardiovascular diseases. The 30-day mortality was 17% in patients with a TnT elevation and 5% in patients with no TnT elevation (p = 0,008). The 1-year mortality was 38% in patients with a TnT elevation and 24% in patients with no TnT elevation (p < 0,05). The 2-year mortality was 48% in patients with a TnT elevation and 31% in patients with no TnT elevation (p=0,01). Elevated TnT level on admission was a strong predictor of mortality at both 1-month, 6/23 (26.1%) vs. 11/171 (6.4%) (p < 0.007), and 1-year, 11/23 (47.8%) vs. 45/171 (26.3%) (p < 0.048). Conclucions: Patients with a hip fracture often develop asymptomatic or clinically unrecognized perioperative myocardial infarctions. Elevated level of TnT in hip fracture patients is a strong predictor of mortality at 1-month, 1-year and 2-years. Earlier diagnosis and appropriate treatment of cardiac infarction might improve survival of hip fracture.

Co-relation between xanthine oxidase and ceruloplasmin in acute myocardial infarction

Myocardial ischemia results from the reduction of coronary flow to such an extent that supply of oxygen to the myocardium does not meet the oxygen demand of myocardial tissue. Xanthine oxidoreductase, under normal conditions, exists in dehydrogenase form. Under ischemic conditions it is converted into xanthine oxidase. Ceruloplasmin is ?2 globulin a glycoprotein, an acute phase protein synthesized by the liver in response to tissue damage. Our aim in this study was to determine levels of xanthine oxidase and ceruloplasmin in acute myocardial infarction.We found that, xanthine oxidase activity in acute myocardial infarction patients increases significantly (p < 0.01) upto 12 hours and then slowly decreases. The maximum activity is found after 12 hours of acute myocardial infarction. While, ceruloplasmin level in the serum of patients increases significantly (p < 0.01) upto 48 hours and then slowly decreases. We found xanthine oxidase and ceruloplasmin have no specific co-relation between them. But, still it is found that xanthine oxidase activity reaches to peak more early as compared to ceruloplasmin. Thus, it is concluded xanthine oxidase is more potent in diagnosis and prognosis of acute myocardial infarction and can be utilized as a marker of oxidative stress developed in acute myocardial infarction.

Application of adenosine stress echocardiography in the prognosis of acute myocardial infarction following percutaneous coronary interventional therapy

The aim of this study was to investigate the application of adenosine stress echocardiography (ASE) in the prognosis of acute myocardial infarction (AMI) following percutaneous coronary intervention (PCI). A total of 79 patients with AMI who underwent PCI were selected for the study. ASE testing was performed within one week following the PCI. Subsequent to the ASE, the patients with ≥5% increases in the left ventricular ejection fraction (LVEF) levels were included in the improved LVEF group, while patients with <5% increases in LVEF levels were included in the unimproved LVEF group. A follow-up study was performed during the 24 months subsequent to the ASE. The incidence of major adverse cardiovascular events (MACEs) was observed and compared between the two groups and logistic regression analysis was applied to identify the risk factors for clinical prognosis. There were no significant differences in Killip classification, LVEF, left ventricular end-diastolic diameter or blood plasma B-type natriuretic peptide concentration between the two groups following PCI. The incidence of MACEs in the improved LVEF group was significantly lower than that in unimproved LVEF group (14.29 versus 43.24%, respectively; P<0.05). Logistic regression analysis identified LVEF increases of <5% and segment improvements of ≤3 as the risk factors for the clinical prognosis of AMI following treatment with PCI. Therefore, ASE is an effective method of assessing the clinical effect of PCI treatment, which may be utilized to predict the incidence of MACEs following PCI.

Early diastolic strain rate in relation to systolic and diastolic function and prognosis in acute myocardial infarction: a two-dimensional speckle-tracking study

Diastolic dysfunction in acute myocardial infarction (MI) is associated with adverse outcome. Recently, the ratio of early mitral inflow velocity (E) to global diastolic strain rate (e'sr) has been proposed as a marker of elevated LV filling pressure. However, the prognostic value of this measure has not been demonstrated in a large-scale setting when existing parameters of diastolic function are known. We hypothesized that the E/e'sr ratio would be independently associated with an adverse outcome in patients with MI. We prospectively included patients with MI and performed echocardiography with comprehensive diastolic evaluation including E/e'sr. The relationship between E/e'sr and the primary composite endpoint (all-cause mortality, hospitalization for heart failure (HF), stroke, and new onset atrial fibrillation) was analysed with Cox models. A total of 1048 patients (mean age 63 ± 12, 73% male) were included and 142 patients (13.5%) reached the primary endpoint (median follow-up 29 months). A significant prognostic value was found for E/e'sr [hazard ratio (HR) per 1 unit change: 2.36, 95% confidence interval (CI): 2.02-2.75, P < 0.0001]. After multivariable adjustment E/e'sr remained independently related to the combined endpoint (HR per 1 unit change, 1.50; CI: 1.05-2.13, P = 0.02). The prognostic value of E/e'sr was driven by mortality (HR per 1 unit change, 2.52; CI: 2.09-3.04, P < 0.0001) and HF admissions (HR per 1 unit change, 2.79; CI: 2.23-3.48, P < 0.0001). Deformation-based E/e'sr contributes important information about global myocardial relaxation superior to velocity-based analysis and is independently associated with the outcome in acute MI.