Absence of chest pain and long-term mortality in patients with acute myocardial infarction

Abstract

ObjectiveChest pain is the predominant symptom in patients with acute myocardial infarction (AMI). A lack of chest pain in patients with AMI is associated with higher in-hospital mortality, but whether this outcome is sustained throughout the first years after onset is unknown. Therefore, we aimed to investigate long-term mortality in patients hospitalised with AMI presenting with or without chest pain.MethodsAll AMI cases registered in the SWEDEHEART registry between 1996 and 2010 were included in the study. In total, we included 172 981 patients (33.5% women) with information on symptom presentation.ResultsPatients presenting without chest pain (12.7%) were older, more often women and had more comorbidities, prior medications and complications during hospitalisation than patients with chest pain. Short-term and long-term mortality rates were higher in patients without chest pain than in patients with chest pain: 30-day mortality, 945 versus 236/1000 person-years; 5-year mortality, 83 versus 21/1000 person-years in patients <65 years. In patients ≥65 years, 30-day mortality was 2294 versus 1140/1000 person-years; 5-year mortality, 259 versus 109/1000 person-years. In multivariable analysis, presenting without chest pain was associated with an overall 5-year HR of 1.85 (95% CI 1.81 to 1.89), with a stronger effect in younger compared with older patients, as well as in patients without prior AMI, heart failure, stroke, diabetes or hypertension.ConclusionAbsence of chest pain in patients with AMI is associated with more complications and higher short-term and long-term mortality rates, particularly in younger patients, and in those without previous cardiovascular disease.

Clinical Impact of Atypical Chest Pain and Diabetes Mellitus in Patients with Acute Myocardial Infarction from Prospective KAMIR-NIH Registry

“…The atypical features of chest pain of non-cardiac origin are considered less urgent and tend to be overlooked and underestimated. Consequently, delayed diagnosis and treatment of these patients, who were eventually diagnosed with acute myocardial infarction (AMI), have known to be associated with unfavorable clinical outcomes [2,[5][6][7].…”

“…There is a lack of evidence on whether atypical chest pain affects long-term clinical outcomes. SWEDEHEART registry included 172,981 AMI patients between 1996 and 2010 [7]. Patients without chest pain were defined as those not having chest pain, including dyspnea and non-specific symptoms.…”

Mortality at 5 Years Among Very Elderly Patients Undergoing High Sensitivity Troponin T Testing for Suspected Acute Coronary Syndromes

“…Patients with advanced age may present to EDs with a variety of symptoms potentially suggestive of an ACS [41][42][43]. Of note, patients presenting to EDs without cardiac chest pain but with high HsTnT levels have very high all-cause mortality [44,45]. Other studies have reported that, compared to younger patients, the very elderly frequently do not have typical chest pain as the main presenting symptom for MI [46][47][48].…”

Evaluation of Molecularly Imprinted Polymers for Point-of-Care Testing for Cardiovascular Disease

“…These routines include biomarker analysis to evaluate the risk of developing CVD or to identify its early onset and are most often conducted in primary care settings. Moreover, a high proportion of deaths attributed to CVD occur in asymptomatic individuals who may have been classified as high-risk following a cardiovascular screening [231,232,233,234]. Several cardiovascular risk estimation systems have been developed to assist in the risk profiling of patients, with Figure 9 depicting an adapted and simplified SCORE risk estimation chart that displays only a limited selection of key risk factors [235,236].…”