Comparison of Door-to-Balloon Time and 30-Day Mortality According to Symptom Presentation in Patients With Acute Myocardial Infarction

Abstract

Background: We hypothesized that symptom presentation in patients with acute myocardial infarction (AMI) may affect their management and subsequent outcome. Methods and Results: Using Rural AMI Registry data, 1,337 consecutive patients with AMI who underwent percutaneous coronary intervention were analyzed. Typical symptoms were defined as any symptoms of chest pain or pressure due to myocardial ischemia. We considered the specific symptoms of dyspnea, nausea, or vomiting as atypical symptoms. The primary outcome was 30-day mortality. There were 150 (11.2%) and 1,187 (88.8%) patients who presented with atypical and typical symptoms, respectively. Those who presented with atypical symptoms were significantly older (mean [±SD] age 74±12 vs. 68±13 years; P<0.001) and had a higher Killip class (46.7% vs. 21.8%; P<0.001) than patients presenting with typical symptoms. The prevalence of door-to-balloon time of ≤90 min was significantly lower in patients with atypical than typical symptoms (40.0% vs. 66.3%; P<0.001). At 30 days, there were 55 incidents of all-cause death. Multivariate Cox proportional hazards regression analysis revealed that symptom presentation was associated with 30-day mortality (hazard ratio 2.33; 95% confidence interval 1.20–4.38; P<0.05). Conclusions: Atypical symptoms in patients with AMI are less likely to lead to timely reperfusion and are associated with increased risk of 30-day mortality.

Initial symptoms of myocardial infarction – Consequences and methodological approach

“…[3][4][5] The 30-day mortality among MI patients presenting without chest pain have been estimated to 7-31%, whereas the equivalent mortality among chest pain MI patients was 2-9%. 3,29,33 A similar pattern was found for long-term mortality where the 1-year mortality was estimated to 4-17% and 15-23% in MI patients with and without chest pain. 3,28,30 Overall, previous findings indicate that the mortality risk is two to three times higher among non-chest pain MI patients compared to chest pain patients.…”

“…2,5,9,[26][27][28] The literature suggests that the prevalence of MI patients presenting without chest pain is between 8% and 44% depending on the selection of MI patients. 1,2,4,[29][30][31][32][33] Previous studies have indicated that symptom presentation varies according to type of MI, where absence of chest pain have been found more common for NSTEMI, where 23% to 44% presented without chest pain, 4,28,30 whereas symptom presentation without chest pain among STEMI patients is somewhat less common (13% and 27%). 4,29,31 Advancement in treatment during the past decades has contributed to a considerable reduction in mortality after MI.…”

“…These include being younger, being male, having a family history of coronary artery disease, having hypercholesterolemia/dyslipidemia, and smoking. 1,28,33,37 These factors could contribute to the observed differences in mortality between MI patients with and without chest pain.…”

Impact of the COVID-19 pandemic on the hospitalizations, time course, presenting symptoms, and mid-term outcomes in patients with myocardial infarctions in a Japanese multi-center registry

“…Patients misinterpreting MI symptoms, such as atypical symptoms, which are sometimes similar to COVID-19-related symptoms, might have interfered with an early diagnosis of an MI by choosing home recuperation [ 15 ]. In general, atypical symptoms in MI patients are reported to have a longer time-to-admission and reperfusion, and higher short-term mortality [ 14 , 23 ]. However, in the present study, there was no significant difference in the rate of symptom presentation and STATs in the NSTEMI patients between the after-pandemic period and pre-pandemic period, which might result in no difference in the 180-day mortality between the two time periods.…”

“…Typical symptoms were defined as any symptoms of chest pain or pressure with/without radiating to the arm, shoulder, neck, or jaw. Atypical symptoms were defined as any symptoms due to myocardial ischemia other than typical symptoms, including shortness of breath, nausea, abdominal pain, and loss of consciousness [ 14 ]. If the patients had a cardiopulmonary arrest at admission, it was defined as an OHCA.…”