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

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    Authors
    Canto, Andrew J.
    Kiefe, Catarina I.
    Goldberg, Robert J.
    Rogers, William J.
    Peterson, Eric D.
    Wenger, Nanette K.
    Vaccarino, Viola
    Frederick, Paul D.
    Sopko, George
    Zheng, Zhi-Jie
    Canto, John G.
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    UMass Chan Affiliations
    Meyers Primary Care Institute
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2012-04-01
    Keywords
    Aged
    Aged, 80 and over
    Chest Pain
    Female
    *Hospital Mortality
    Humans
    Logistic Models
    Male
    Middle Aged
    Multivariate Analysis
    Myocardial Infarction
    Registries
    Biostatistics
    Cardiovascular Diseases
    Epidemiology
    Health Services Research
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    Link to Full Text
    http://dx.doi.org/10.1016/j.ahj.2012.01.020
    Abstract
    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.
    Source
    Am Heart J. 2012 Apr;163(4):572-9. Epub 2012 Mar 29. Link to article on publisher's site
    DOI
    10.1016/j.ahj.2012.01.020
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/46548
    PubMed ID
    22520522
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ahj.2012.01.020
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