the mechanism and magnitude of the cardiac remodelling process in traumatic acute myocardial infarction remain unknown. objective: to characterize and quantify the process in patients who developed traumatic myocardial infarction secondary to penetrating heart wound, and to compare it with patients without infarction. methods: a prospective, observational cohort study was carried out in patients with myocardial infarction secondary to penetrating heart wound. the exposed cohort comprised all patients with traumatic myocardial infarction and the non-exposed cohort comprised the patients without infarction. results: there were 31 male patients, two female patients, mean age was 31 years. more than 90 percent of the wounds were caused by a sharp, pointed weapon. at the baseline, the ejection fraction and fractional shortening were significantly lower in the patients with infarction (52% vs 70%, p< 0.0001; 27.6% vs 35.1%, p< 0.001, respectively). at the six-month follow-up, the only variable significantly different between the two groups was the fractional shortening (30.18 vs. 34.72, p < 0.05). patients with penetrating heart wound and with secondary traumatic ami have a rr of 2.67 (95% ci 0.72-9.89) of developing eccentric hypertrophy after six months. conclusions: patients with penetrating heart wounds with and without infarction showed a tendency to develop a remodelling process with eccentric hypertrophy. the differences encountered, however, are not significant and a longer follow-up is required, as well as a larger number of patients. (acta med colomb 2012; 37: 6-13).