Differences in symptom presentation and hospital mortality according to type of acute myocardial infarction

被引：67

作者：

Canto, Andrew J. ^{[3
]}

Kiefe, Catarina I. ^{[4
]}

Goldberg, Robert J. ^{[4
]}

Rogers, William J. ^{[5
]}

Peterson, Eric D. ^{[6
]}

Wenger, Nanette K. ^{[7
]}

Vaccarino, Viola ^{[7
,8
]}

Frederick, Paul D. ^{[9
]}

Sopko, George ^{[10
]}

Zheng, Zhi-Jie ^{[11
]}

Canto, John G. ^{[1
,2
]}

机构：

[1] Watson Clin, Lakeland, FL 33805 USA

[2] Lakeland Reg Med Ctr, Lakeland, FL USA

[3] Int Baccalaureate Sch, Bartow, FL USA

[4] Univ Massachusetts, Sch Med, Dept Quantitat Hlth Sci, Worcester, MA USA

[5] Univ Alabama, Med Ctr, Birmingham, AL 35294 USA

[6] Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC USA

[7] Emory Sch Med, Dept Med, Div Cardiol, San Francisco, CA USA

[8] Emory Univ, Dept Epidemiol, Rollins Sch Publ Hlth, San Francisco, CA USA

[9] ICON Late Phase & Outcomes Res, San Francisco, CA USA

[10] NHLBI, Bethesda, MD 20892 USA

[11] Shanghai Jiao Tong Univ, Sch Publ Hlth, Shanghai 200030, Peoples R China

来源：

AMERICAN HEART JOURNAL | 2012年 / 163卷 / 04期

关键词：

ACUTE CORONARY SYNDROMES; CHEST-PAIN; REGISTRY;

D O I：

10.1016/j.ahj.2012.01.020

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Chest pain/discomfort (CP) is the hallmark symptom of acute myocardial infarction (MI), but some patients with MI present without CP. We hypothesized that MI type (ST-segment elevation MI [STEMI] or non-STEMI [NSTEMI]) may be associated with the presence or absence of CP. Methods We investigated the association between CP at presentation and MI type, hospital care, and mortality among 1,143,513 patients with MI in the National Registry of Myocardial Infarction (NRMI) from 1994 to 2006. Results Overall, 43.6% of patients with NSTEMI and 27.1% of patients with STEMI presented without CP. For both MI type, patients without CP were older, were more frequently female, had more diabetes or history of heart failure, were more likely to delay hospital arrival, and were less likely to receive evidence-based medical therapies and invasive cardiac procedures. Multivariable analysis indicated that NSTEMI (vs STEMI) was the strongest predictor of atypical symptoms (adjusted odds ratio [95% CI], 1.93 [1.91-1.95]). Within the 4 CP/MI type categories, hospital mortality was highest for no CP/STEMI (27.8%), followed by no CP/NSTEMI (15.3%) and CP/STEMI (9.6%), and was lowest for CP/NSTEMI (5.4%). The adjusted odds ratio of mortality was 1.38 (1.35-1.41) for no CP (vs CP) in the STEMI group and 1.31 (1.28-1.34) in the NSTEMI group. Conclusions Hospitalized patients with NSTEMI were nearly 2-fold more likely to present without CP than patients with STEMI. Patients with MI without CP were less quickly diagnosed and treated and had higher adjusted odds of hospital mortality, regardless of whether they had ST-segment elevation. (Am Heart J 2012; 163:572-9.)

引用

页码：572 / 579

页数：8

共 9 条

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