Prevalence, Clinical Characteristics, and Mortality Among Patients With Myocardial Infarction Presenting Without Chest Pain

CONTEXT Although chest pain is widely considered a key symptom in the diagnosis of myocardial infarction (MI), not all patients with MI present with chest pain. The extent to which this phenomenon occurs is largely unknown. OBJECTIVES To determine the frequency with which patients with MI present wi...

Full description

Saved in:
Bibliographic Details
Published in:JAMA : the journal of the American Medical Association 2000-06, Vol.283 (24), p.3223-3229
Main Authors: Canto, John G, Shlipak, Michael G, Rogers, William J, Malmgren, Judith A, Frederick, Paul D, Lambrew, Costas T, Ornato, Joseph P, Barron, Hal V, Kiefe, Catarina I
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Biological and medical sciences
Cardiology. Vascular system
Chest Pain
Emergency Medical Services
Female
Heart
Heart attacks
Hospital Mortality
Humans
Logistic Models
Male
Medical diagnosis
Medical sciences
Middle Aged
Mortality
Multivariate Analysis
Myocardial Infarction - diagnosis
Myocardial Infarction - mortality
Myocardial Infarction - therapy
Myocarditis. Cardiomyopathies
Pain
Prevalence
Prospective Studies
Therapy
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:CONTEXT Although chest pain is widely considered a key symptom in the diagnosis of myocardial infarction (MI), not all patients with MI present with chest pain. The extent to which this phenomenon occurs is largely unknown. OBJECTIVES To determine the frequency with which patients with MI present without chest pain and to examine their subsequent management and outcome. DESIGN Prospective observational study. SETTING AND PATIENTS A total of 434,877 patients with confirmed MI enrolled June 1994 to March 1998 in the National Registry of Myocardial Infarction 2, which includes 1674 hospitals in the United States. MAIN OUTCOME MEASURES Prevalence of presentation without chest pain; clinical characteristics, treatment, and mortality among MI patients without chest pain vs those with chest pain. RESULTS Of all patients diagnosed as having MI, 142,445 (33%) did not have chest pain on presentation to the hospital. This group of MI patients was, on average, 7 years older than those with chest pain (74.2 vs 66.9 years), with a higher proportion of women (49.0% vs 38.0%) and patients with diabetes mellitus (32.6% vs 25.4%) or prior heart failure (26.4% vs 12.3%). Also, MI patients without chest pain had a longer delay before hospital presentation (mean, 7.9 vs 5.3 hours), were less likely to be diagnosed as having confirmed MI at the time of admission (22.2% vs 50.3%), and were less likely to receive thrombolysis or primary angioplasty (25.3% vs 74.0%), aspirin (60.4% vs 84.5%), β-blockers (28.0% vs 48.0%), or heparin (53.4% vs 83.2%). Myocardial infarction patients without chest pain had a 23.3% in-hospital mortality rate compared with 9.3% among patients with chest pain (adjusted odds ratio for mortality, 2.21 [95% confidence interval, 2.17-2.26]). CONCLUSIONS Our results suggest that patients without chest pain on presentation represent a large segment of the MI population and are at increased risk for delays in seeking medical attention, less aggressive treatments, and in-hospital mortality.
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.283.24.3223