A Hybrid Approach for Turning Intention Prediction Based on Time Series Forecasting and Deep Learning

At an intersection with complex traffic flow, the early detection of the intention of drivers in surrounding vehicles can enable advanced driver assistance systems (ADAS) to warn the driver in advance or prompt its subsystems to assess the risk and intervene early. Although different drivers show various driving characteristics, the kinematic parameters of human-driven vehicles can be used as a predictor for predicting the driver's intention within a short time. In this paper, we propose a new hybrid approach for vehicle behavior recognition at intersections based on time series prediction and deep learning networks. First, the lateral position, longitudinal position, speed, and acceleration of the vehicle are predicted using the online autoregressive integrated moving average (ARIMA) algorithm. Next, a variant of the long short-term memory network, called the bidirectional long short-term memory (Bi-LSTM) network, is used to detect the vehicle's turning behavior using the predicted parameters, as well as the derived parameters, i.e., the lateral velocity, lateral acceleration, and heading angle. The validity of the proposed method is verified at real intersections using the public driving data of the next generation simulation (NGSIM) project. The results of the turning behavior detection show that the proposed hybrid approach exhibits significant improvement over a conventional algorithm; the average recognition rates are 94.2% and 93.5% at 2 s and 1 s, respectively, before initiating the turning maneuver.

Human-Like Obstacle Avoidance Trajectory Planning and Tracking Model for Autonomous Vehicles That Considers the River's Operation Characteristics

Developing a human-like autonomous driving system has gained increasing amounts of attention from both technology companies and academic institutions, as it can improve the interpretability and acceptance of the autonomous system. Planning a safe and human-like obstacle avoidance trajectory is one of the critical issues for the development of autonomous vehicles (AVs). However, when designing automatic obstacle avoidance systems, few studies have focused on the obstacle avoidance characteristics of human drivers. This paper aims to develop an obstacle avoidance trajectory planning and trajectory tracking model for AVs that is consistent with the characteristics of human drivers' obstacle avoidance trajectory. Therefore, a modified artificial potential field (APF) model was established by adding a road boundary repulsive potential field and ameliorating the obstacle repulsive potential field based on the traditional APF model. The model predictive control (MPC) algorithm was combined with the APF model to make the planning model satisfy the kinematic constraints of the vehicle. In addition, a human driver's obstacle avoidance experiment was implemented based on a six-degree-of-freedom driving simulator equipped with multiple sensors to obtain the drivers' operation characteristics and provide a basis for parameter confirmation of the planning model. Then, a linear time-varying MPC algorithm was employed to construct the trajectory tracking model. Finally, a co-simulation model based on CarSim/Simulink was established for off-line simulation testing, and the results indicated that the proposed trajectory planning controller and the trajectory tracking controller were more human-like under the premise of ensuring the safety and comfort of the obstacle avoidance operation, providing a foundation for the development of AVs.

Generation of GGTA1-/-β2M-/-CIITA-/- Pigs Using CRISPR/Cas9 Technology to Alleviate Xenogeneic Immune Reactions

BACKGROUND

Xenogeneic organ transplantation has been proposed as a potential approach to fundamentally solve organ shortage problem. Xenogeneic immune responses across species is one of the major obstacles for clinic application of xeno-organ transplantation. The generation of glycoprotein galactosyltransferase α 1, 3 (GGTA1) knockout pigs has greatly contributed to the reduction of hyperacute xenograft rejection. However, severe xenograft rejection can still be induced by xenoimmune responses to the porcine major histocompatibility complex antigens swine leukocyte antigen class I and class II.

METHODS

We simultaneously depleted GGTA1, β2-microglobulin (β2M), and major histocompatibility complex class II transactivator (CIITA) genes using clustered regularly interspaced short palindromic repeats and CRISPR-associated proteins technology in Bamma pig fibroblast cells, which were further used to generate GGTA1β2MCIITA triple knockout (GBC-3KO) pigs by nuclear transfer.

RESULTS

The genotype of GBC-3KO pigs was confirmed by polymerase chain reaction and Sanger sequencing, and the loss of expression of α-1,3-galactose, SLA-I, and SLA-II was demonstrated by flow cytometric analysis using fluorescent-conjugated lectin from bandeiraea simplicifolia, anti-β2-microglobulin, and swine leukocyte antigen class II DR antibodies. Furthermore, mixed lymphocyte reaction assay revealed that peripheral blood mononuclear cells from GBC-3KO pigs were significantly less effective than (WT) pig peripheral blood mononuclear cells in inducing human CD3CD4 and CD3CD8 T-cell activation and proliferation. In addition, GBC-3KO pig skin grafts showed a significantly prolonged survival in immunocompetent C57BL/6 mice, when compared with wild-type pig skin grafts.

CONCLUSIONS

Taken together, these results demonstrate that elimination of GGTA1, β2M, and CIITA genes in pigs can effectively alleviate xenogeneic immune responses and prolong pig organ survival in xenogenesis. We believe that this work will facilitate future research in xenotransplantation.

Three-dimensional printed navigational template for localizing small pulmonary nodules: A case-controlled study

Background

Localization of small pulmonary nodules is an inevitable challenge for the thoracic surgeon. This study aimed to investigate the accuracy of three‐dimensional (3D) printing technology for localizing small pulmonary nodules, especially ground‐glass nodules (GGNs).

Methods

This study enrolled patients with peripheral small pulmonary nodules (≤ 2 cm) who required preoperative localization. In the comparison period, patients underwent both computed tomography‐guided (CT‐G) and 3D‐printing template guided (3D‐G) localization to compare the accuracies of the two methods. In the testing period, the 3D‐printing technique was implemented alone. The 3D‐printing physical navigational template was designed based on data from perioperative CT images. Clinical data, imaging data, surgical data, and evaluation index were collected for further analysis. The learning curve of the 3D‐printing localization technique was assessed using cumulative sum (CUSUM) analysis and multiple linear regression analysis.

Results

In the comparison period (n = 14), the success rates of CT‐G and 3D‐G were 100% and 92.9% (P = 0.31), respectively; in the testing period (n = 23), the success rate of 3D‐G was 95.6%. The localization times of CT‐G, 3D‐G (comparison), and 3D‐G (testing) were 23.6 ± 5.3, 19.3 ± 6.8, and 9.8 ± 4.6 minutes, respectively. The CUSUM learning curve was modeled using the equation: Y = 0.48X²− 0.013X − 0.454 (R² = 0.89). The learning curve was composed of two phases, phase 1 (the initial 20 patients) and phase 2 (the remaining 17 patients).

Conclusions

3D printing localization has adequate accuracy and is a feasible and accessible strategy for use in localizing small pulmonary nodules, especially in right upper lobe. The use of this technique could facilitate lung nodule localization prior to surgery.

Circulating miR-106b-5p serves as a diagnostic biomarker for asymptomatic carotid artery stenosis and predicts the occurrence of cerebral ischemic events

This study aimed to investigate the expression and diagnostic value of miR-106b-5p in asymptomatic carotid artery stenosis (CAS) patients, and further explore its predictive value for the occurrence of cerebral ischemic events (CIE). A total of 58 asymptomatic CAS cases and 61 healthy controls were recruited. Quantitative RT-PCR was applied for the measurement of the miR-106b-5p level. The receiver operating characteristic (ROC) curve was plotted to assess the diagnostic value of miR-106b-5p for CAS. Kaplan–Meier methods and Cox regression analysis were performed to assess the predictive value of miR-106b-5p for the occurrence of CIE. In patients with asymptomatic CAS, miR-106b-5p was highly expressed. The miR-106b-5p level showed a significant association with dyslipidemia, hypertension, and the degree of carotid stenosis. miR-106b-5p had a relative accuracy in differentiating patients with asymptomatic CAS from healthy individuals, with a sensitivity of 89.7% and specificity of 83.6% at the cutoff value of 0.198. Patients with high miR-106b-5p expression experienced more CIE. miR-106b-5p was highly expressed in patients with asymptomatic CAS. Our present results provide evidence for miR-106b-5p as a promising biomarker for CAS diagnosis, and for predicting the risk of future CIE in patients with asymptomatic CAS.

Case report of a patient with suspected COVID-19 with depression and fever in an epidemic stress environment

During the COVID-19 pandemic, the number of suspected cases, confirmed cases and those who passed away from the virus has been reported in major media and the internet, and has caused a high degree of tension. In addition, people’s outdoor activities have been limited, making it more difficult to find outlets for releasing stress. Under this situation, some people began to experience emotions of anxiety and depression. This article reports a case of depression with fever caused by the stress tension of the pandemic. The patient was highly suspected to have contracted COVID-19. The reported patient, who had a history of depression and had been to Wuhan to attend an exam, showed obvious pre-exam anxiety under the epidemic situation, which gradually increased the patient's pressure and then caused some adverse symptoms, such as insomnia, anxiety, sweating and a reoccurrent fever. Local community authorities paid close attention to him and later sent him to a general hospital in Jingmen for quarantine and treatment, as he was suspected of having COVID-19. After being hospitalised for half a month, he was ruled out from having ‘COVID-19’ and was cured of depression and discharged from the hospital. From this case, we can realise that, under the situation of the epidemic, people are easily prone to insomnia, anxiety and even depression. As clinicians in general hospitals, especially when encountering large emergencies, we must carefully inquire about the patient’s medical history while strengthening our understanding of psychiatric knowledge to improve the recognition rate for depression.

Family aggregation of pulmonary ground-glass nodules: Identification of multiple candidate risk loci

e13512

Background: Lung cancer with family history have been emerging gradually of late years in East Asian, especially those presenting as pulmonary ground-glass nodules (GGNs). The predisposition of GGNs with lung cancer family history remains baffling. Methods: This prospective study was registered at clinicaltrials.gov (number NCT04220268) and enrolled patients with pulmonary pre-invasive or invasive adenocarcinoma, especially presenting as GGNs. We collected blood and tumor samples from 29 GGNs patients with family history to investigated germline and somatic mutations by whole exome sequencing (WES). As the first part of our study, we focused on 107 nonoverlapping susceptibility loci for lung carcinogenesis identified by recent genome-wide association studies (GWAS) to identify novel rare causal variants. Potential causal variants were further verified in other patients from the families when possible. Results: A total of 461267 single neocleotide variants (SNVs) and 132268 insertion-deletions (InDels) were detected from the 29 index patients. By focusing on exome profiles of the 107 target loci, we identified three key rare mutations, namely MSH5 p.Ala702Thr, ADGRG6 p.Asn338Ile and CCDC147 p.Arg619Trp in two index patients respectively. The minor allele frequency (MAF) of these three variants was extremely low in the general population, which is 1/5008, 2/5008 and 6/5008 respectively in the 1000 Genomes database, and 2/31406, 5/31346, and 5/31394 respectively in the GnomAD database. There three mutations were predicted as probably damaging or disease-causing variations by SIFT or Polyphen. Mutations of MSH5 and CCDC147 were also detected in other patients from the two families. Conclusions: With the identification of highly disruptive risk-conferring MSH5, ADGRG6 and CCDC147 mutations, we confirmed the probably heritable and risk loci exists in the GGNs patients with lung cancer family history in East Asians. Exome sequencing has great potential to identify novel rare causal variants, and more analyses on more patients are still ongoing.

Real-World Scenario of Patients With Lung Cancer Amid the Coronavirus Disease 2019 Pandemic in the People's Republic of China

Introduction

The coronavirus disease 2019 (COVID-19) outbreak throughout the world has affected millions of people in many ways, putting a huge burden on the health care system. The ongoing outbreak of this respiratory disease has posed critical challenges to public health, research, and medical communities around the world. This study aimed at evaluating the impact of COVID-19 pandemic on patients with lung cancer in the People's Republic of China.

Methods

We collected data on 397 inpatients from a single center during 4 weeks of the pandemic (2020 group) and that of 2504 inpatients during the same period (4 wk) in the past 5 years (2015-2019 group). A questionnaire was used to investigate the medical demands of 803 patients with lung cancer at 65 hospitals in 20 provinces in the People's Republic of China during the pandemic. We evaluated the incidence data of COVID-19 in Guangdong to analyze the tendency of the pandemic and compared it with inpatient data.

Results

The number of hospitalizations and lung cancer-related operations had steadily increased from 2015 to 2019 but reduced by an average of 26.72% (133.8) and 57.18% (45.4) in 2020. The hospital capacity decreased by 28.00% (35 inpatient beds) during the pandemic period of infection with severe acute respiratory syndrome coronavirus 2. The pandemic caused a greater impact on medical work related to lung cancer after the Chinese New Year holiday. Patients were most concerned about long waiting times for outpatient services, inpatient beds, physical examinations, or operations (406; 50.56%); the possibility of infection with the novel coronavirus (359; 44.71%); and the difficulties in getting to a hospital owing to transportation outages (279; 34.74%). Patients in stage I and II revealed having less fear about disease progression (14 [18.18%] and four [14.81%], respectively), had lower proportions of delayed medical arrangement (15 [19.48%] and six [22.22%], respectively), and complained less about complex treatment procedures (12 [15.58%] and five [18.52%], respectively). Patients in the high-infected area (345, 56.74%) complained more frequently about longer booking periods than those in the low-infected area (61, 31.28%).

Conclusions

The treatment of patients with lung cancer has been affected by the pandemic to some extent. We provide suggestions on both clinical diagnosis and treatment strategies for lung cancer to optimize the process, given the urgency of the current circumstances. The demand for medical support among patients with lung cancer or other life-threatening diseases should be given sufficient attention, especially during the current COVID-19 outbreak.

A 51 bp indel polymorphism within the PTH1R gene is significantly associated with chicken growth and carcass traits

Parathyroid hormone (PTH) is a crucial regulator of calcium homeostasis and bone remodeling, and the parathyroid hormone 1 receptor (PTH1R) belongs to a class II G-protein-coupled receptor. PTH activates PTH1R, which mediates catabolic and anabolic processes in the skeleton. However, the functional mechanism of PTH1R has not been thoroughly elucidated in organisms. This study identified a 51 bp indel mutation in the first intron of the PTH1R gene and elucidated the effect of this gene mutation on the growth and carcass traits in chickens. The results indicated that the 51 bp indel was significantly associated with subcutaneous fat thickness, abdominal fat weight, body weight and daily gain over 4-8 weeks. Furthermore, we found that PTH1R gene expression was highest in the kidney and liver tissues, and it showed a trend of decreasing in leg and breast muscle tissues at different embryonic stages. In addition, we examined the expression of the three genotypes of the PTH1R gene in the liver, breast muscle and abdominal fat and found that the II genotype was significantly higher than the DD and ID genotypes. In summary, these findings suggest that the PTH1R gene can serve as a potential molecular marker for chicken breeding.

Research on the Influence of Vehicle Speed on Safety Warning Algorithm: A Lane Change Warning System Case Study

Speed has an important impact on driving safety, however, this factor is not included in existing safety warning algorithms. This study uses lane change systems to study the influence of vehicle speed on safety warning algorithms, aiming to determine lane change warning rules for different speeds (DS-LCW). Thirty-five drivers are recruited to carry out an extreme trial and naturalistic driving experiment. The vehicle speed, relative speed, relative distance, and minimum safety deceleration (MSD) related to lane change characteristics are then analyzed and calculated as warning rule characterization parameters. Lane change warning rules for a rear vehicle in the target lane under four-speed levels of 60 ≤ v < 70 km/h, 70 ≤ v < 80 km/h, 80 ≤ v < 90 km/h, and v ≥ 90 km/h are established. The accuracy of lane change warning rules not considering speed level (NDS-LCW) and ISO 17387 are found to be 87.5% and 79.8%, respectively. Comparatively, the accuracy rate of DS-LCW under four-speed levels is 94.6%, 93.8%, 90.0%, and 92.6%, respectively, which is significantly superior. The algorithm proposed in this paper provides warning in the lane change process with a smaller relative distance, and the accuracy rate of DS-LCW is significantly superior to NDS-LCW and ISO 17387.

Cyclist detection and tracking based on multi-layer laser scanner

The technology of Artificial Intelligence (AI) brings tremendous possibilities for autonomous vehicle applications. One of the essential tasks of autonomous vehicle is environment perception using machine learning algorithms. Since the cyclists are the vulnerable road users, cyclist detection and tracking are important perception sub-tasks for autonomous vehicles to avoid vehicle-cyclist collision. In this paper, a robust method for cyclist detection and tracking is presented based on multi-layer laser scanner, i.e., IBEO LUX 4L, which obtains four-layer point cloud from local environment. First, the laser points are partitioned into individual clusters using Density-Based Spatial Clustering of Applications with Noise (DBSCAN) method based on subarea. Then, 37-dimensional feature set is optimized by Relief algorithm and Principal Component Analysis (PCA) to produce two new feature sets. Support Vector Machine (SVM) and Decision Tree (DT) classifiers are further combined with three feature sets, respectively. Moreover, Multiple Hypothesis Tracking (MHT) algorithm and Kalman filter based on Current Statistical (CS) model are applied to track moving cyclists and estimate the motion state. The performance of the proposed cyclist detection and tracking method is validated in real road environment.

What is the difference between perceived and actual risk of distracted driving? A field study on a real highway

Distracted driving is a leading cause of traffic accidents. It is influenced by driver attitude toward secondary tasks; however, field-based studies on the effects of low-perceived-risk tasks on lateral driving have rarely been reported. A total of 17 experienced non-professional drivers were recruited to participate in two secondary tasks: a cognitive experiment (conversation) and a visual distraction experiment (observation of following vehicles), each representing low-perceived-risk secondary tasks. One-way analysis of variance (ANOVA) was conducted to evaluate the effects of low-perceived-risk tasks on lateral driving performance. ANOVA results indicated that compared with baseline (no task) lateral performance, lane-keeping ability was enhanced during cognitive distractions. In the visual distraction experiment, more than 50% of the distractions required 1–2 s. Lane deviation and its growth rate increased with the duration of distraction. Compared with cognitive distraction, lane deviation increased significantly with visual distraction, and lane-keeping performance was seriously impaired. For low-perceived-risk tasks, visual distractions impaired driving safety more seriously, compared with cognitive distractions, suggesting that drivers misjudge the risks associated with visual tasks. These results can contribute to the design of advanced driving-assistance systems and improve professional driver programs, potentially reducing the frequency of traffic accidents caused by distracted driving.

clustifyr: an R package for automated single-cell RNA sequencing cluster classification

Assignment of cell types from single-cell RNA sequencing (scRNA-seq) data remains a time-consuming and error-prone process. Current packages for identity assignment use limited types of reference data and often have rigid data structure requirements. We developed the clustifyr R package to leverage several external data types, including gene expression profiles to assign likely cell types using data from scRNA-seq, bulk RNA-seq, microarray expression data, or signature gene lists. We benchmark various parameters of a correlation-based approach and implement gene list enrichment methods. clustifyr is a lightweight and effective cell-type assignment tool developed for compatibility with various scRNA-seq analysis workflows. clustifyr is publicly available at https://github.com/rnabioco/clustifyr

Management of type 2 diabetes using non-insulin glucose-lowering therapies: a critical appraisal of clinical practice guidelines with the AGREE II instrument

AIM

Type 2 diabetes is a major global epidemic affecting over 400 million people worldwide. The objective of this systematic review was to provide an overview of recommendations from clinical practice guidelines (guidelines) addressing non-insulin based pharmacological management of among non-pregnant adults in an outpatient setting, and critically appraise their methodological development.

METHODS

We systematically searched MEDLINE and Embase databases, for relevant guidelines using the Ovid interface. We scanned the bibliographies of all eligible guidelines for additional relevant citations. Teams of two reviewers, independently and in duplicate, screened titles and abstracts and potentially eligible full text reports to determine eligibility and appraised the reporting quality of guidelines using the Advancing Guideline Development, Reporting and Evaluation in Health Care instrument II (AGREE II) instrument.

RESULTS

Our search yielded 11264 unique citations, of which 124 were retrieved for full-text review; 17 guidelines proved eligible. The highest scoring AGREE domain was 'clarity of presentation' (66%; range 7-92%), followed by 'scope and purpose' (58%; range 25-92%), 'editorial independence' (55%; range 0-91%), 'stakeholder involvement' (45%; range 11-90%) and 'rigour of development' (43%; range 4-92%). The poorest domain was 'applicability' (37%; range 6-84%). The guidelines authored by the World Health Organization group achieved the highest AGREE overall score.

CONCLUSIONS

Most of the guidelines provided recommendations with a local jurisdictional focus and showed significant variation in the quality. Nevertheless, only a small number of those scored well overall.

clustifyr: an R package for automated single-cell RNA sequencing cluster classification

Assignment of cell types from single-cell RNA sequencing (scRNA-seq) data remains a time-consuming and error-prone process. Current packages for identity assignment use limited types of reference data and often have rigid data structure requirements. We developed the clustifyr R package to leverage several external data types, including gene expression profiles to assign likely cell types using data from scRNA-seq, bulk RNA-seq, microarray expression data, or signature gene lists. We benchmark various parameters of a correlation-based approach and implement gene list enrichment methods. clustifyr is a lightweight and effective cell-type assignment tool developed for compatibility with various scRNA-seq analysis workflows. clustifyr is publicly available at https://github.com/rnabioco/clustifyr.

Monocytic Subclones Confer Resistance to Venetoclax-Based Therapy in Patients with Acute Myeloid Leukemia

Venetoclax-based therapy can induce responses in approximately 70% of older previously untreated patients with acute myeloid leukemia (AML). However, up-front resistance as well as relapse following initial response demonstrates the need for a deeper understanding of resistance mechanisms. In the present study, we report that responses to venetoclax +azacitidine in patients with AML correlate closely with developmental stage, where phenotypically primitive AML is sensitive, but monocytic AML is more resistant. Mechanistically, resistant monocytic AML has a distinct transcriptomic profile, loses expression of venetoclax target BCL2, and relies on MCL1 to mediate oxidative phosphorylation and survival. This differential sensitivity drives a selective process in patients which favors the outgrowth of monocytic subpopulations at relapse. Based on these findings, we conclude that resistance to venetoclax + azacitidine can arise due to biological properties intrinsic to monocytic differentiation. We propose that optimal AML therapies should be designed so as to independently target AML subclones that may arise at differing stages of pathogenesis. SIGNIFICANCE: Identifying characteristics of patients who respond poorly to venetoclax-based therapy and devising alternative therapeutic strategies for such patients are important topics in AML. We show that venetoclax resistance can arise due to intrinsic molecular/metabolic properties of monocytic AML cells and that such properties can potentially be targeted with alternative strategies.

Academic Self-Perceptions and Academic Achievement in Chinese Children: A Multiwave Longitudinal Study

This study examined reciprocal contributions between academic self-perceptions and academic achievement. Data were collected each year in four consecutive years from a sample of children in China (initial N = 1,156; 581 boys; initial M_age  = 9.33 years). Analyses using random intercept cross-lagged panel models revealed that the effects of academic achievement on self-perceptions tended to be more evident in lower grades and the effects of academic self-perceptions on achievement tended to be more evident in higher grades. Latent growth curve analyses showed that the initial level of academic self-perceptions and achievement moderated the growth of each other. The results indicate the contributions between academic self-perceptions and achievement that occur in a progressive cascading manner in Chinese children.

Relationship between speed perception and eye movement-A case study of crash-involved and crash-not-involved drivers in China

Speed perception tests are already used in several countries as part of the driver licensing curriculum; however, this test is not compulsively required in China. The purpose of this study was to investigate the relationship between speed perception and eye movement for different driver groups. Forty-eight drivers, including 28 crash-involved (CI), with rear-end or side collisions, and 20 crash-not-involved (CNI) drivers, were recruited for the speed perception experiments. Drivers’ reaction characteristics as well as eye movement data were analyzed. The results showed that CI drivers were more likely to overestimate the speed of visual stimuli and react in advance. The speed perception of CI drivers was more accurate than that of CNI drivers for visual stimuli with middle to high moving speeds, indicating that CNI drivers are more cautious and conservative when driving. Regarding eye movement, significant differences in saccade speed were found between the CI and CNI drivers in the occlusion area under high speed and the occlusion ratio. The relationship between visual pattern and speed perception accuracy was found to some extent. Implications of the speed perception test for the driver aptitude test were discussed.

Angiographic characteristics and in-hospital mortality among patients with ST-segment elevation myocardial infarction presenting without typical chest pain: an analysis of China Acute Myocardial Infarction registry

Background:

Patients with ST-segment elevation myocardial infarction (STEMI) who present without typical chest pain are associated with a poor outcome. However, whether angiographic characteristics are related to a higher risk of mortality in this population is unclear. This study aimed to investigate whether the higher mortality risk in patients with STEMI without chest pain could be explained by their “high-risk” angiographic characteristics.

Methods:

We used data of 12,145 patients with STEMI who was registered in China Acute Myocardial Infarction registry from January 2013 to September 2014. We compared the infarct-related artery (IRA), thrombolysis in myocardial infarction (TIMI) flow grade in the IRA, and other angiographic characteristics between patients without and those with chest pain. Multivariable logistic regression model was used to identify independent risk factor of in-hospital mortality.

Results:

The 2922 (24.1%) patients with STEMI presented without typical chest pain. These patients had a higher TIMI flow grade (mean TIMI flow grade: 1.00 vs. 0.94, P = 0.02) and a lower rate of IRA disease of the left anterior descending artery (44.6% vs. 51.2%, χ² = 35.63, P < 0.01) than did those with typical chest pain. Patients without chest pain were older, more likely to have diabetes, longer time to hospital and higher Killip classification, and less likely to receive optimal medication treatment and primary percutaneous coronary intervention and higher In-hospital mortality (3.3% vs. 2.2%, χ² = 10.57, P < 0.01). After adjusting for multi-variables, presentation without chest pain was still an independent predictor of in-hospital death among patients with STEMI (adjusted odds ratio: 1.36, 95% confidence interval: 1.02–1.83).

Conclusions:

Presentation without chest pain is common and associated with a higher in-hospital mortality risk in patients with acute myocardial infarction. Our results indicate that their poor prognosis is associated with baseline patient characteristics and delayed treatment, but not angiographic lesion characteristics.

Clinical trial registration:

NCT01874691, https://clinicaltrials.gov.