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dc.contributor.authorCanto, Andrew J.
dc.contributor.authorKiefe, Catarina I.
dc.contributor.authorGoldberg, Robert J.
dc.contributor.authorRogers, William J.
dc.contributor.authorPeterson, Eric D.
dc.contributor.authorWenger, Nanette K.
dc.contributor.authorVaccarino, Viola
dc.contributor.authorFrederick, Paul D.
dc.contributor.authorSopko, George
dc.contributor.authorZheng, Zhi-Jie
dc.contributor.authorCanto, John G.
dc.date2022-08-11T08:10:33.000
dc.date.accessioned2022-08-23T17:12:38Z
dc.date.available2022-08-23T17:12:38Z
dc.date.issued2012-04-01
dc.date.submitted2012-10-15
dc.identifier.citationAm Heart J. 2012 Apr;163(4):572-9. Epub 2012 Mar 29. <a href="http://dx.doi.org/10.1016/j.ahj.2012.01.020" target="_blank">Link to article on publisher's site</a>
dc.identifier.issn0002-8703 (Linking)
dc.identifier.doi10.1016/j.ahj.2012.01.020
dc.identifier.pmid22520522
dc.identifier.urihttp://hdl.handle.net/20.500.14038/46548
dc.description.abstractBACKGROUND: 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.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=22520522&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1016/j.ahj.2012.01.020
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectChest Pain
dc.subjectFemale
dc.subject*Hospital Mortality
dc.subjectHumans
dc.subjectLogistic Models
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectMultivariate Analysis
dc.subjectMyocardial Infarction
dc.subjectRegistries
dc.subjectBiostatistics
dc.subjectCardiovascular Diseases
dc.subjectEpidemiology
dc.subjectHealth Services Research
dc.titleDifferences in symptom presentation and hospital mortality according to type of acute myocardial infarction
dc.typeJournal Article
dc.source.journaltitleAmerican heart journal
dc.source.volume163
dc.source.issue4
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/qhs_pp/1014
dc.identifier.contextkey3393446
html.description.abstract<p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p>
dc.identifier.submissionpathqhs_pp/1014
dc.contributor.departmentMeyers Primary Care Institute
dc.contributor.departmentDepartment of Quantitative Health Sciences
dc.source.pages572-9


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