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Shin MA, Oh S, Kim MC, Sim DS, Hong YJ, Kim JH, Ahn Y, Jeong MH. Time to presentation and mortality outcomes among patients with diabetes and acute myocardial infarction. Korean J Intern Med 2024; 39:110-122. [PMID: 38086620 PMCID: PMC10790041 DOI: 10.3904/kjim.2023.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/04/2023] [Accepted: 09/25/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND/AIMS Due to limited real-world evidence on the association between time to presentation (T2P) and outcomes following acute myocardial infarction and diabetes (AMI-DM), we investigated the characteristics of patients with AMI-DM and their outcomes based on their T2P. METHODS 4,455 patients with AMI-DM from a Korean nationwide observational cohort (2011-2015) were divided into early and late presenters according to symptom-to-door time. The effects of T2P on three-year all-cause mortality were estimated using inverse probability of treatment weighting (IPTW) and survival analysis. RESULTS The incidence of all-cause mortality was consistently higher in late presenters than in early presenters (11.4 vs. 17.2%; p < 0.001). In the IPTW-adjusted dataset, the incidence of all-cause mortality was numerically higher in late presenters than in early presenters (9.1 vs. 12.4%; p = 0.072). In the survival analysis, the cumulative incidence of all-cause mortality was significantly higher in late presenters than in early presenters before and after IPTW. In the subgroup with ST-elevation myocardial infarction, late presenters had a higher incidence of cardiac death than early presenters before (4.8 vs. 10.5%; p < 0.001) and after IPTW (4.2 vs. 9.7%; p = 0.034). In the initial glycated hemoglobin (HbA1c)-stratified analysis, these effects were attenuated in patients with HbA1c ≥ 9.0% before (adjusted hazard ratio [HR]: 1.45, 95% confidence interval [CI]: 0.80-2.64) and after IPTW (adjusted HR: 0.82, 95% CI: 0.40-1.67). CONCLUSION Late presentation was associated with higher mortality in patients with AMI-DM; therefore, multifaceted and systematic interventions are needed to decrease pre-hospital delays.
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Affiliation(s)
- Min-A Shin
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- The Cardiovascular Convergence Research Center Nominated by Korea Ministry for Health and Welfare, Gwangju,
Korea
| | - Seok Oh
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- The Cardiovascular Convergence Research Center Nominated by Korea Ministry for Health and Welfare, Gwangju,
Korea
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- The Cardiovascular Convergence Research Center Nominated by Korea Ministry for Health and Welfare, Gwangju,
Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju,
Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- The Cardiovascular Convergence Research Center Nominated by Korea Ministry for Health and Welfare, Gwangju,
Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju,
Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- The Cardiovascular Convergence Research Center Nominated by Korea Ministry for Health and Welfare, Gwangju,
Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju,
Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- The Cardiovascular Convergence Research Center Nominated by Korea Ministry for Health and Welfare, Gwangju,
Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju,
Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- The Cardiovascular Convergence Research Center Nominated by Korea Ministry for Health and Welfare, Gwangju,
Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju,
Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju,
Korea
- The Cardiovascular Convergence Research Center Nominated by Korea Ministry for Health and Welfare, Gwangju,
Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju,
Korea
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Nakahashi T, Sakata K, Masuda J, Kumagai N, Higuma T, Ogimoto A, Tanigawa T, Hanada H, Nakamura M, Takamura M, Dohi K. Comparison of Door-to-Balloon Time and 30-Day Mortality According to Symptom Presentation in Patients With Acute Myocardial Infarction. Circ Rep 2021; 3:194-200. [PMID: 33842724 PMCID: PMC8024011 DOI: 10.1253/circrep.cr-21-0006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/09/2022] Open
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.
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Affiliation(s)
| | - Kenji Sakata
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Jun Masuda
- Department of Cardiology, Mie Prefectural General Medical Center Yokkaichi Japan
| | | | - Takumi Higuma
- Division of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | | | - Takashi Tanigawa
- Department of Cardiology, Matsusaka Chuo General Hospital Matsusaka Japan
| | - Hiroyuki Hanada
- Department of Disaster and Critical Care Medicine, Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Mashio Nakamura
- Department of Internal Medicine, Pediatrics and Cardiology, Nakamura Medical Clinic Kuwana Japan
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine Tsu Japan
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Sato N, Minami Y, Ako J, Maeda A, Akashi Y, Ikari Y, Ebina T, Tamura K, Namiki A, Fukui K, Michishita I, Kimura K, Suzuki H. Clinical significance of prehospital 12-lead electrocardiography in patients with ST-segment elevation myocardial infarction presenting with syncope: from a multicenter observational registry (K-ACTIVE study). Heart Vessels 2021; 36:1466-1473. [PMID: 33710375 DOI: 10.1007/s00380-021-01832-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/05/2021] [Indexed: 11/26/2022]
Abstract
Patients with acute myocardial infarction (AMI) presenting with syncope have poor clinical outcomes partly due to a delay in the diagnosis. Although the impact of prehospital 12-lead electrocardiography (PHECG) on the reduction of first medical contact (FMC)-to-device time and subsequent adverse clinical events in patients with AMI has been demonstrated, the impact of PHECG for the patients presenting with syncope remains to be elucidated. This study aimed to explore the impact of PHECG on 30-day mortality in patients with ST-segment elevation myocardial infarction (STEMI) presenting with syncope. From a cohort of multi-center registry [Kanagawa-ACuTe cardIoVascular rEgistry (K-ACTIVE)], a total of 90 consecutive patients with STEMI presenting with syncope were included. The 30-day mortality were compared between patients with PHECG (PHECG group, n = 25) and those without PHECG (non-PHECG group, n = 65). There was no significant difference in the baseline clinical characteristics between the 2 groups. FMC-to-device time was significantly shorter in the PHECG group than in the non-PHECG group (122 [86, 128] vs. 131 [102, 153] min, p = 0.03) due to the shorter door-to-device time. Thirty-day mortality was significantly lower in the PHECG group than in the non-PHECG group (16.0 vs. 44.6%, p = 0.03). In conclusion, PHECG was associated with shorter FMC-to-device time and lower 30-day mortality in patients with STEMI presenting with syncope.
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Affiliation(s)
- Nobuhiro Sato
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0375, Japan
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0375, Japan.
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0375, Japan
| | - Atsuo Maeda
- Showa University Fujigaoka Hospital, Yokohama, Japan
| | | | - Yuji Ikari
- Tokai University School of Medicine, Isehara, Japan
| | - Toshiaki Ebina
- Yokohama City University Medical Center, Yokohama, Japan
| | - Kouichi Tamura
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | | | - Kazuki Fukui
- Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | | | - Kazuo Kimura
- Yokohama City University Medical Center, Yokohama, Japan
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Pong JZ, Ho AFW, Tan TXZ, Zheng H, Pek PP, Sia CH, Hausenloy DJ, Ong MEH. ST-segment elevation myocardial infarction with non-chest pain presentation at the Emergency Department: Insights from the Singapore Myocardial Infarction Registry. Intern Emerg Med 2019; 14:989-997. [PMID: 31165979 DOI: 10.1007/s11739-019-02122-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/28/2019] [Indexed: 12/12/2022]
Abstract
ST-segment elevation myocardial infarction (STEMI) often presents acutely at the Emergency Department (ED). Although chest pain is a classical symptom, a significant proportion of patients do not present with chest pain. The impact of a non-chest pain (NCP) presentation on ED processes-of-care and outcomes is not fully understood. We utilised a national registry to characterise predictors, processes-of-care, and outcomes of NCP STEMI presentations. Retrospective data for all STEMI cases occurring between 2010 and 2012 were analysed from the Singapore Myocardial Infarction Registry. Cases of inpatient onset, inter-facility transfers, and out-of-hospital cardiac arrests were excluded. Univariable analysis of demographic, clinical, processes-of-care, and outcome variables was conducted. Multivariable logistic regression ascertained independent predictors of a NCP presentation and 28-day mortality. Of 4667 STEMI cases, 12.9% presented without chest pain. Patients with NCP presentation were older (median, years = 74 vs. 58; p < 0.001), more likely to be female (39.1% vs. 15.7%; p < 0.001), of the Chinese race (72.5% vs. 62.7%; p < 0.001), and with diabetes (48.6% vs. 36.7%; p < 0.001). These patients were more likely to present with syncope (6.0% vs. 1.9%; p < 0.001) or epigastric pain (10.6% vs. 4.9%; p < 0.001). Patients with NCP presentation were less likely to receive percutaneous coronary intervention (27.0% vs. 75.6%; p < 0.001), had longer door-to-balloon time (median, minutes = 83 vs. 63; p < 0.001), and experienced greater mortality at 28 days (31.2% vs. 4.5%; p < 0.001). On multivariable logistic regression, independent predictors of a NCP presentation included age (adjusted odds ratio [aOR] = 1.05, 95% confidence interval [CI] 1.04-1.07), diabetes (aOR = 1.76, 95% CI 1.40-2.19), BMI (aOR = 0.93, 95% CI 0.91-0.96), and dyslipidemia (aOR = 0.73, 95% CI 0.58-0.91). Absence of chest pain was an independent predictor for 28-day mortality (aOR = 3.46, 95% CI 2.64-4.52). Patients who presented with a NCP STEMI had a distinct clinical profile and experienced poorer outcomes. Routine triage ECG could be considered for patients with high-risk factors and non-classical symptoms.
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Affiliation(s)
- Jeremy Zhenwen Pong
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Andrew Fu Wah Ho
- SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore, Singapore
- Signature Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
| | | | - Huili Zheng
- National Registry of Diseases Office, Health Promotion Board, Singapore, Singapore
| | - Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Derek John Hausenloy
- Signature Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- The Hatter Cardiovascular Institute, University College London, London, UK
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, Research and Development, London, UK
- Tecnologico de Monterrey, Centro de Biotecnologia-FEMSA, Nuevo León, Mexico
| | - Marcus Eng Hock Ong
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
- Health Service Research Centre, Singapore Health Services, Academia, 20 College Road, Singapore, 169856, Singapore.
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Painless myocardial infarction - a clinical challenge in the emergency department. CAN J EMERG MED 2019; 21:557-559. [DOI: 10.1017/cem.2019.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Fu R, Song CX, Dou KF, Yang JG, Xu HY, Gao XJ, Liu QQ, Xu H, Yang YJ. Differences in symptoms and pre-hospital delay among acute myocardial infarction patients according to ST-segment elevation on electrocardiogram: an analysis of China Acute Myocardial Infarction (CAMI) registry. Chin Med J (Engl) 2019; 132:519-524. [PMID: 30807351 PMCID: PMC6416090 DOI: 10.1097/cm9.0000000000000122] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Approximately 70% patients with acute myocardial infarction (AMI) presented without ST-segment elevation on electrocardiogram. Patients with non-ST segment elevation myocardial infarction (NSTEMI) often presented with atypical symptoms, which may be related to pre-hospital delay and increased risk of mortality. However, up to date few studies reported detailed symptomatology of NSTEMI, particularly among Asian patients. The objective of this study was to describe and compare symptoms and presenting characteristics of NSTEMI vs. STEMI patients. METHODS We enrolled 21,994 patients diagnosed with AMI from China Acute Myocardial Infarction (CAMI) Registry between January 2013 and September 2014. Patients were divided into 2 groups according to ST-segment elevation: ST-segment elevation (STEMI) group and NSTEMI group. We extracted data on patients' characteristics and detailed symptomatology and compared these variables between two groups. RESULTS Compared with patients with STEMI (N = 16,315), those with NSTEMI (N = 5679) were older, more often females and more often have comorbidities. Patients with NSTEMI were less likely to present with persistent chest pain (54.3% vs. 71.4%), diaphoresis (48.6% vs. 70.0%), radiation pain (26.4% vs. 33.8%), and more likely to have chest distress (42.4% vs. 38.3%) than STEMI patients (all P < 0.0001). Patients with NSTEMI were also had longer time to hospital. In multivariable analysis, NSTEMI was independent predictor of presentation without chest pain (odds ratio: 1.974, 95% confidence interval: 1.849-2.107). CONCLUSIONS Patients with NSTEMI were more likely to present with chest distress and pre-hospital patient delay compared with patients with STEMI. It is necessary for both clinicians and patients to learn more about atypical symptoms of NSTEMI in order to rapidly recognize myocardial infarction. TRIAL REGISTRATION www.clinicaltrials.gov (No. NCT01874691).
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Affiliation(s)
- Rui Fu
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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Frampton J, Devries JT, Welch TD, Gersh BJ. Modern Management of ST-Segment Elevation Myocardial Infarction. Curr Probl Cardiol 2018; 45:100393. [PMID: 30660333 DOI: 10.1016/j.cpcardiol.2018.08.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 08/31/2018] [Indexed: 12/31/2022]
Abstract
Disruption of intracoronary plaque with thrombus formation resulting in severe or total occlusion of the culprit coronary artery provides the pathophysiologic foundation for ST-segment elevation myocardial infarction (STEMI). Management of STEMI focuses on timely restoration of coronary blood flow along with antithrombotic therapies and secondary prevention strategies. The purpose of this review is to discuss the epidemiology, pathophysiology, and diagnosis of STEMI. In addition, the review will focus on guideline-directed therapy for these patients and review potential associated complications.
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Anderson KL, Shah NA, Gallegos M, Chiang IH. Asymptomatic ST elevation myocardial infarction. Heart Lung 2018; 47:363-365. [PMID: 29861276 DOI: 10.1016/j.hrtlng.2018.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 04/28/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND A 71-year-old non-smoking female with a history of diabetes, hypertension, hyperlipidemia and end-stage renal disease presented to the emergency department for right leg pain due to an ankle fracture. CASE The patient's initial electrocardiogram (ECG) revealed ST segment elevations in the anterior leads. She denied any chest pain, shortness of breath, fatigue, lightheadedness, palpitations, nausea or diaphoresis. Her initial laboratory Troponin I resulted 35.9 ng/mL. Coronary catheterization demonstrated 99% occlusion of the left anterior descending (LAD) coronary artery. The patient had 2 drug eluting stents placed in the LAD with 10% residual stenosis. CONCLUSION Although witnessing an ongoing asymptomatic ST elevation myocardial infarction (STEMI) is rare, this case highlights the importance of early revascularization when the ECG demonstrates a STEMI, even in the absence of symptoms for patients at risk for silent myocardial infarctions.
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Affiliation(s)
- Kenton L Anderson
- Department of Emergency Medicine, Stanford University School of Medicine, 900 Welch Road, Palo Alto, CA 94304, USA.
| | - Neel A Shah
- Department of Emergency Medicine, Baylor College of Medicine, 1504 Taub Loop, Houston, TX 77030, USA
| | - Moises Gallegos
- Department of Emergency Medicine, Baylor College of Medicine, 1504 Taub Loop, Houston, TX 77030, USA
| | - I-Hui Chiang
- Department of Medicine, Division of Cardiology, Baylor College of Medicine, 1220 Main St., Houston, TX 77030, USA
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Puymirat E, Aissaoui N, Bonello L, Cayla G, Labèque JN, Nallet O, Motreff P, Varenne O, Schiele F, Ferrières J, Simon T, Danchin N. Clinical outcomes according to symptom presentation in patients with acute myocardial infarction: Results from the FAST-MI 2010 registry. Clin Cardiol 2017; 40:1256-1263. [PMID: 29243857 DOI: 10.1002/clc.22819] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/08/2017] [Accepted: 09/16/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Atypical clinical presentation in acute myocardial infarction (AMI) patients is not uncommon; most studies suggest that it is associated with unfavorable prognosis. HYPOTHESIS Long-term clinical impact differs according to predominant symptom presentation (typical chest pain, atypical chest pain, syncope, cardiac arrest, or dyspnea) in AMI patients. METHODS FAST-MI 2010, a nationwide French registry, included 4169 patients with AMI in 213 centers at the end of 2010 (76% of active centers). Demographics, medical history, hospital management, and outcomes were compared according to predominant symptom presentation. RESULTS Typical chest pain with no other symptom was reported in 3020 patients (68% in STEMI patients, 76% in NSTEMI patients). Atypical chest pain, dyspnea, syncope, and cardiac arrest were reported in 11%, 11%, 5%, and 1%, respectively. Patients with atypical clinical presentation had a higher cardiovascular risk profile and received fewer medications and a less invasive strategy. Using Cox multivariate analysis, atypical chest pain was not associated with higher death rate at 3 years (HR: 0.96, 95% CI: 0.69-1.33, P = 0.78), whereas cardiac arrest (HR: 2.44, 95% CI: 1.00-5.97, P = 0.05), syncope (HR: 1.70, 95% CI: 1.18-2.46, P = 0.005), and dyspnea (HR: 1.66, 95% CI: 1.31-2.10, P < 0.001) were associated with higher long-term mortality compared with patients with typical isolated chest pain. Similar trends were observed in STEMI and NSTEMI populations. CONCLUSIONS Atypical clinical presentation is observed in about 20% of AMI patients. Cardiac arrest, dyspnea, and syncope represent independent predictors of long-term mortality in STEMI and NSTEMI populations.
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Affiliation(s)
- Etienne Puymirat
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), Université Paris-Descartes, Paris, France
| | - Nadia Aissaoui
- Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), Paris, France
| | - Laurent Bonello
- Department of Cardiology, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Nord, Marseille, France
| | - Guillaume Cayla
- Department of Cardiology, University Hospital of Nimes, University of Nimes, France
| | | | - Olivier Nallet
- Department of Cardiology, Intercity Hospital Le Raincy-Montfermeil, Montfermeil, France
| | - Pascal Motreff
- Department of Cardiology, University Hospital of Clermont-Ferrand, UMR 6284 Auvergne University, Clermont-Ferrand, France
| | - Olivier Varenne
- Department of Cardiology, AP-HP, Hôpital Cochin, Université Paris-Descartes, Paris, France
| | - François Schiele
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France
| | - Jean Ferrières
- Department of Cardiology, Rangueil Hospital, Toulouse, France
| | - Tabassome Simon
- Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), AP-HP, Hôpital Saint Antoine, Paris, France.,Sorbonne Universités, UPMC Paris Univ-06, Paris, France
| | - Nicolas Danchin
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), Université Paris-Descartes, Paris, France
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Fujino M, Ishihara M, Ogawa H, Nakao K, Yasuda S, Noguchi T, Ozaki Y, Kimura K, Suwa S, Fujimoto K, Nakama Y, Morita T, Shimizu W, Saito Y, Hirohata A, Morita Y, Inoue T, Okamura A, Uematsu M, Ako J, Nakai M, Nishimura K, Miyamoto Y. Impact of symptom presentation on in-hospital outcomes in patients with acute myocardial infarction. J Cardiol 2016; 70:29-34. [PMID: 27856131 DOI: 10.1016/j.jjcc.2016.10.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/16/2016] [Accepted: 10/07/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Limited data exist regarding the association between symptom presentation of acute myocardial infarction (AMI) and in-hospital outcomes. METHODS We analyzed data of the Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET). This was a prospective and multicenter registry consisting of 3085 AMI patients with available data of symptoms, who were hospitalized within 48h from onset during July 2012 to March 2014. We defined typical symptoms as any of chest pain or pressure due to myocardial ischemia. RESULTS Of this study population, 642 patients (20.8%) had atypical symptoms (atypical group) and the remaining 2443 patients (79.2%) showed typical symptoms (typical group). Compared to the typical group, the atypical group was associated with higher age, more females, hypertension, diabetes, chronic kidney disease, history of cardiovascular disease, non-ST elevation MI, and Killip class ≥2. In the atypical group, urgent percutaneous coronary intervention was less frequently performed than in the typical group, and in STEMI patients door-to-balloon time was longer in the atypical than typical group. Atypical group had larger infarct size than typical group. Furthermore, in-hospital mortality was significantly higher in atypical than in typical group (19.5% vs. 3.3%, p<0.001). In multivariable analysis, presence of atypical symptoms was an independent predictor of in-hospital mortality (odds ratio 3.12, 95% confidence interval 2.19 to 4.47, p<0.001). Moreover, the association between atypical symptoms and mortality was consistent across each subgroup. CONCLUSIONS Atypical symptoms of AMI were associated with less invasive therapy and poor outcome. Attention should be directed to these high-risk patients.
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Affiliation(s)
- Masashi Fujino
- Division of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Division of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masaharu Ishihara
- Division of Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan.
| | - Hisao Ogawa
- Division of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Division of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Satoshi Yasuda
- Division of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Division of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Teruo Noguchi
- Division of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Division of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University, Toyoake, Japan
| | - Kazuo Kimura
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Kazuteru Fujimoto
- Department of Cardiology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Yasuharu Nakama
- Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan
| | - Takashi Morita
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshihiko Saito
- First Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Atsushi Hirohata
- Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Atsunori Okamura
- Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Masaaki Uematsu
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University, Tokyo, Japan
| | - Michikazu Nakai
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiro Miyamoto
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan
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11
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Reperfusion treatment delays amongst patients with painless ST segment elevation myocardial infarction. CAN J EMERG MED 2016; 19:355-363. [PMID: 27681496 DOI: 10.1017/cem.2016.376] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Early reperfusion therapy in the treatment of ST segment elevation myocardial infarction (STEMI) patients can improve outcomes. Silent myocardial infarction is associated with poor prognosis, but little is known about its effect on treatment delays. We aimed to characterize STEMI patients presenting without complaints of pain to the emergency departments (EDs) in Singapore. METHODS Retrospective data were requested from the Singapore Myocardial Infarction Registry (SMIR), a national level registry in Singapore. Painless STEMI was defined as the absence of pain (chest, back, shoulder, jaw, and epigastric pain) during ED presentation. The primary outcome was door-to-balloon (D2B) time, defined as the earliest time a patient arrived in the ED to balloon inflation. Secondary outcomes were 1-month and 1-year mortality and occurrence of adverse events. RESULTS From January 2010 to December 2012, the SMIR collected 6412 cases; 10.9% of patients presented without any pain. These patients were older (median age =75 v. 58 years old), more likely to be females (39.9% v. 16.1%), Chinese (74.9% v. 62.7%), obese (median body mass index [BMI] =24.5 v. 22.1), and with history of hypertension (71.1% v. 54.6%), diabetes mellitus (48.6% v. 37.0%), and acute myocardial infarction (20.0% v. 12.3%). They had a longer median D2B (80.5 v. 63 minutes, p<0.001) and a higher occurrence of 30-day (38.4% v. 5.7%) and 1-year mortality rates (47.3% v. 8.5%). CONCLUSION A small proportion of STEMI patients presented without any pain to the ED. They tended to have a higher D2B and risks of mortality. Targeted effort is required to improve diagnostic and treatment efficiency in this group.
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12
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Characteristics and Outcomes of MI Patients with and without Chest Pain: A Cohort Study. Heart Lung Circ 2015; 24:796-805. [DOI: 10.1016/j.hlc.2015.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 12/01/2014] [Accepted: 01/24/2015] [Indexed: 11/21/2022]
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Jeong MH. Searching for the key to improve infarcted cardiac wall motion and prevent ventricular remodeling after ST-segment elevation myocardial infarction: Beyond symptom-onset-to-balloon time. Anatol J Cardiol 2015; 15:371-2. [PMID: 25993712 PMCID: PMC5779172 DOI: 10.5152/akd.2015.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Myung Ho Jeong
- Professor, Principal Investigator of Korea Acute Myocardial Infarction Registry, Director of The Heart Research Center Nominated by Korea Ministry of Health and Welfare, Chonnam National University Hospital; Dongku, Gwangju-Republic of Korea.
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14
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Park JS, Cha KS, Shin D, Lee DS, Lee HW, Oh JH, Choi JH, Lee HC, Hong TJ, Jeong MH, Ahn Y, Chae SC, Kim YJ. Impact of non-chest pain complaint as a presenting symptom on door-to-balloon time and clinical outcomes in patients with acute ST-elevation myocardial infarction. Am J Cardiol 2014; 114:1801-9. [PMID: 25438905 DOI: 10.1016/j.amjcard.2014.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/14/2014] [Accepted: 09/14/2014] [Indexed: 11/18/2022]
Abstract
Many patients with ST-elevation myocardial infarctions (STEMIs) have non-chest pain complaints and are given low priority during triage. This prospective, multicenter, observational, registry-based study investigated the impact of non-chest pain complaints on door-to-balloon (DTB) time and clinical outcomes. Patients with STEMI who had undergone primary percutaneous coronary intervention were compared with respect to the presence of chest pain or non-chest pain complaints as presenting symptoms. To eliminate biased estimates, a propensity score model was built, and 2 cohorts of 1:1 matched patients were obtained. Propensity matching identified 2 cohorts of 976 patients each. After comparing patients with chest pain and those with non-chest pain complaints, significant delays in the median DTB time were noted (74 vs 84 minutes, respectively; p <0.001). Non-chest pain complaints were independent predictors of DTB time in the multivariate linear regression models. In-hospital mortality (adjusted hazard ratio [HR] 1.402, 95% confidence interval [CI] 0.727 to 2.705, p = 0.313), all-cause mortality (adjusted HR 1.175, 95% CI 0.453 to 3.853, p = 0.642), and major adverse cardiac events at follow-up (adjusted HR 0.139, 95% CI 0.876 to 1.48, p = 0.331) did not differ between the 2 groups of patients. In conclusion, short- and long-term clinical outcomes in patients with STEMI with non-chest pain complaints do not differ from those of patients with chest pain as the presenting symptom, despite having delayed diagnosis and reperfusion.
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Affiliation(s)
- Jin Sup Park
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Kwang Soo Cha
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea; Medical Research Institute, Pusan National University Hospital, Busan, South Korea.
| | - Donghun Shin
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Dae Sung Lee
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Hye Won Lee
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Jun-Hyok Oh
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Jung Hyun Choi
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Han Cheol Lee
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Taek Jong Hong
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Shung Chull Chae
- Department of Cardiology, Kyungpook National University Hospital, Daegu, South Korea
| | - Young Jo Kim
- Department of Cardiology, Yeungnam University Hospital, Daegu, South Korea
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15
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Kim HK, Jeong MH, Lee SH, Sim DS, Hong YJ, Ahn Y, Kim CJ, Cho MC, Kim YJ. The scientific achievements of the decades in Korean Acute Myocardial Infarction Registry. Korean J Intern Med 2014; 29:703-12. [PMID: 25378967 PMCID: PMC4219958 DOI: 10.3904/kjim.2014.29.6.703] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 09/08/2014] [Indexed: 11/27/2022] Open
Abstract
The Korea Acute Myocardial Infarction Registry (KAMIR) was the first nationwide registry data collection designed to track outcomes of patients with acute myocardial infarction (AMI). These studies reflect the current therapeutic approaches and management for AMI in Korea. The results of KAMIR could help clinicians to predict the prognosis of their patients and identify better diagnostic and treatment tools to improve the quality of care. The KAMIR score was proposed to be a predictor of the prognosis of AMI patients. Triple antiplatelet therapy, consisting of aspirin, clopidogrel and cilostazol, was effective at preventing major adverse clinical outcomes. Drug-eluting stents were effective and safe in AMI patients with no increased risk of stent thrombosis. Statin therapy was effective in Korean AMI patients, including those with very low levels of low density cholesterol. The present review summarizes the 10-year scientific achievements of KAMIR from admission to outpatient care during long-term clinical follow-up.
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Affiliation(s)
- Hyun Kuk Kim
- The Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- The Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Seung Hun Lee
- The Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- The Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- The Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- The Heart Center, Chonnam National University Hospital, Gwangju, Korea
| | - Chong Jin Kim
- Cardiovascular Center, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Myeong Chan Cho
- Cardiovascular Center, Chungbuk National University Hospital, Cheongju, Korea
| | - Young Jo Kim
- Cardiovascular Center, Yeungnam University Medical Center, Daegu, Korea
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16
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Abdallah M, Raza R, Abdallah T, McCord D, Khoueiry G. A rare case of silent transmural myocardial infarction with diffuse ST elevations complicated by concomitant severe hyperkalemia. Heart Lung 2014; 43:286-8. [PMID: 24856226 DOI: 10.1016/j.hrtlng.2014.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 04/14/2014] [Accepted: 04/17/2014] [Indexed: 11/29/2022]
Abstract
It is well described that certain group of patients do not display the typical symptoms of myocardial infarction (MI). Elderly patients, diabetics and those with previous coronary artery bypass graft surgery are at high risk for silent MI. The diagnosis of Acute MI in the emergency room (ER) is mainly based on the electrocardiogram (EKG) findings of ST elevations or new onset left bundle branch block which is supported by the clinical presentation and positive biomarkers when present. The diagnoses can sometimes become challenging when the patient is asymptomatic and has coincidental finding of hyperkalemia with diffuse ST segment elevations simulating that seen with electrolyte disturbance. Despite the well known pseudoinfarction pattern of hyperkalemia, acute MI should be ruled out first. A high index of suspicion is needed, especially in high risk patients. We think that in rare clinical situation when the diagnosis is in doubt, MI should be ruled out, as time has a high impact on patient mortality. An urgent bedside echocardiogram is very beneficial in excluding regional wall motion abnormalities and preventing any delay in destination therapy for transmural MI. We present a 67 years old female with history of diabetes and chronic kidney disease sent by her nephrologist to the ER for severe hyperkalemia (Potassium 7.2 milliequivalent/L). She was found to have ST elevations on EKG despite having no chest pain or distress. On cardiac catheterization she had a total occlusion of the proximal left circumflex artery, with a filling defect consistent with large thrombus.
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Affiliation(s)
- Mokhtar Abdallah
- Department of Medicine, Staten Island University Hospital (SIUH), New York, USA
| | - Rehan Raza
- Department of Medicine, Staten Island University Hospital (SIUH), New York, USA
| | - Tarek Abdallah
- Department of Medicine, Division of Pulmonary, Staten Island University Hospital (SIUH), New York, USA
| | - Donald McCord
- Department of Medicine, Division of Cardiology, Staten Island University Hospital (SIUH), New York, USA
| | - Georges Khoueiry
- Department of Medicine, Division of Cardiology, Staten Island University Hospital (SIUH), New York, USA.
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17
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Lee KH, Jeong MH, YoungkeunAhn, Kim SS, Rhew SH, Jeong YW, Jang SY, Cho JY, Jeong HC, Park KH, Yoon NS, Sim DS, Yoon HJ, Kim KH, Hong YJ, Park HW, Kim JH, Cho JG, Park JC, Cho MC, Kim CJ, Kim YJ. One-year clinical impact of cardiac arrest in patients with first onset acute ST-segment elevation myocardial infarction. Int J Cardiol 2014; 175:147-53. [PMID: 24856807 DOI: 10.1016/j.ijcard.2014.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 04/22/2014] [Accepted: 05/05/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cardiac arrest complicating acute ST elevation myocardial infarction (STEMI) is known to be associated with increased in-hospital mortality. However, little is known about the long-term outcomes after cardiac arrest complicating first onset STEMI in contemporary percutaneous coronary intervention (PCI) era. METHODS We analyzed 7942 consecutive patients who were diagnosed with STEMI and had no previous history of MI. They were divided into two groups according to the presence of cardiac arrest (group I, patients with cardiac arrest; n=481, group II, patients without cardiac arrest; n=7641). RESULTS In a stepwise multivariate model, previous history of chronic kidney disease, high serum level of glucose and low high density lipoprotein-cholesterol was an independent predictor of cardiac arrest complicating STEMI. Group I had significantly higher in-hospital mortality (adjusted hazard ratio [HR] 3.06, 95% confidence interval [CI] 2.08-4.51, p<0.001) and 30-day mortality after hospital discharge (adjusted HR 2.92, 95% CI 1.86-4.58, log-rank p<0.001). However, there was no significant increase in mortality beyond 30 days (6-month, adjusted HR 1.46, 95% CI 0.45-4.77, log rank p=0.382; 1-year, adjusted HR 1.84, 95% CI 0.83-4.05, log-rank p=0.107). Also, there were no significant differences in 6-month and 1-year major adverse cardiac events in 30-day survivors. Performing PCI was associated with decreased 12-month mortality in 30-day survivors. CONCLUSIONS Although patients with cardiac arrest complicating first onset STEMI had higher in-hospital and 30-day mortality after hospital discharge, cardiac arrest itself did not have any residual impact on mortality as well as clinical outcomes.
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Affiliation(s)
- Ki Hong Lee
- Chonnam National University Hospital, Gwangju, South Korea
| | - Myung Ho Jeong
- Chonnam National University Hospital, Gwangju, South Korea.
| | - YoungkeunAhn
- Chonnam National University Hospital, Gwangju, South Korea
| | - Sung Soo Kim
- Chonnam National University Hospital, Gwangju, South Korea
| | - Shi Hyun Rhew
- Chonnam National University Hospital, Gwangju, South Korea
| | | | - Soo Young Jang
- Chonnam National University Hospital, Gwangju, South Korea
| | - Jae Yeong Cho
- Chonnam National University Hospital, Gwangju, South Korea
| | | | - Keun-Ho Park
- Chonnam National University Hospital, Gwangju, South Korea
| | - Nam Sik Yoon
- Chonnam National University Hospital, Gwangju, South Korea
| | - Doo Sun Sim
- Chonnam National University Hospital, Gwangju, South Korea
| | - Hyun Ju Yoon
- Chonnam National University Hospital, Gwangju, South Korea
| | - Kye Hun Kim
- Chonnam National University Hospital, Gwangju, South Korea
| | | | | | - Ju Han Kim
- Chonnam National University Hospital, Gwangju, South Korea
| | - Jeong Gwan Cho
- Chonnam National University Hospital, Gwangju, South Korea
| | - Jong Chun Park
- Chonnam National University Hospital, Gwangju, South Korea
| | | | | | - Young Jo Kim
- Yeungnam University Hospital, Daegu, South Korea
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18
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Puymirat E, Aissaoui N, Simon T, Bataille V, Drouet E, Mulak G, Ferrières J, Danchin N. [Acute myocardial infarction in the elderly. The FAST-MI registry]. Presse Med 2013; 42:1432-41. [PMID: 23886929 DOI: 10.1016/j.lpm.2013.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 04/08/2013] [Indexed: 01/11/2023] Open
Abstract
The FAST-MI 2010 registry collected information on characteristics and management of patients hospitalized for acute myocardial infraction during a one-month period in 213 centers across France, at the end of 2010. Among the 3079 patients included, 31% were aged 75 years or over (25% of those with ST-elevation myocardial infarction, and 38% of those with non-ST-elevation myocardial infarction). The clinical profile and risk factors differ in elderly patients, but chest pain remains the most common presenting symptom, although a substantial percentage of patients also present with signs of heart failure. Elderly individuals receive less recommended medications, including reperfusion therapy for STEMI, with the largest difference observed beyond 85 years of age. In-hospital mortality increases with age, particularly after 85 years, but has decreased compared with previous French surveys.
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Affiliation(s)
- Etienne Puymirat
- Hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, université Paris-Descartes, 75015 Paris, France
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19
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Lee MG, Jeong MH, Lee KH, Park KH, Sim DS, Yoon HJ, Yoon NS, Kim KH, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Comparison of chronic kidney disease and risk for presenting with painless versus nonpainless acute myocardial infarction. Am J Cardiol 2012; 110:790-4. [PMID: 22657394 DOI: 10.1016/j.amjcard.2012.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 05/08/2012] [Accepted: 05/08/2012] [Indexed: 12/29/2022]
Abstract
Chronic kidney disease increases the risk for developing ischemic heart disease, but it has not been well known whether it also affects the manifestation of painless acute myocardial infarction (AMI), which has important clinical implications. The aim of this study was to identify whether chronic kidney disease is associated with the presentation of painless AMI. A total of 2,656 consecutively hospitalized patients with AMI from January 2008 to February 2012 were enrolled. Estimated glomerular filtration rate (eGFR) was calculated using calibrated serum creatinine and the abbreviated Modification of Diet in Renal Disease (MDRD) equation. Patient clinical characteristics, angiographic findings, and the use of medications were reviewed. Multivariate logistic regression analysis was used to examine the association of reduced eGFR and presentation with painless AMI. A total of 2,176 adults with painful AMI and 480 adults with painless AMI were studied, and baseline eGFR was calculated. Mean eGFR was lower in subjects with painless AMI compared to those with painful AMI. Compared to an eGFR >90 ml/min/1.73 m(2), a strong, graded, independent association was observed between reduced eGFR and presentation with painless AMI, with adjusted odds ratios of 1.65 (95% confidence interval 1.16 to 2.36) for an eGFR of 60 to 89 ml/min/1.73 m(2), 2.92 (95% confidence interval 1.89 to 4.52) for an eGFR of 45 to 59 ml/min/1.73 m(2), and 3.44 (95% confidence interval 2.20 to 5.38) for an eGFR <45 ml/min/1.73 m(2). In conclusion, lower eGFR was a strong, independent predictor of presentation with painless AMI versus painful AMI.
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