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A great proportion of patients with acute myocardial infarction (AMI) experience symptoms other than chest pain. These patients were less likely to receive optimal treatment and had poorer outcomes compared to patients with typical chest pain. However, the clinical, angiographical characteristics as well as clinical outcomes of AMI patients with atypical symptoms have not been well described.
Data were extracted from the China myocardial infarction (CAMI) registry between January 2013 and September 2014. Eligible patients were diagnosed with ST-segment elevation myocardial infarction and received coronary angiography within 7 days of symptom onset. Primary outcome was in-hospital death. Multivariable logistic regression analysis was used to explore independent predictors of in-hospital mortality.
A total of 12145 (9778 males and 2367 females) patients were enrolled in our study. A total of 2922 patients (24%) presented without chest pain. Compared with patients with chest pain, patients without chest pain were older, had more diabetes, lower blood pressure and lower level of Killip classification on admission. Patients absent of chest pain had more RCA culprit lesions and fewer LAD lesions, higher TIMI flow grade, fewer thrombus but were less likely to receive emergent percutaneous coronary intervention. In-hospital mortality was significantly higher among patients without chest pain than those with chest pain (3.3% vs. 2.2%, p=0.0011). In multivariable analysis, presentation without chest pain was an independent risk factor of in-hospital mortality.
Patients without chest pain on presentation were common and had more RCA lesions as well as higher TIMI flow grade on angiography. However, they were less likely to receive emergent reperfusion therapy and had a significantly higher risk of in-hospital mortality. Further efforts should be made to rapidly recognize AMI patients presenting without chest pain.
CORONARY: Acute Myocardial Infarction