Masashi Fujino1, Masaharu Ishihara2, Hisao Ogawa1, Koichi Nakao3, Satoshi Yasuda1, Teruo Noguchi1, Yukio Ozaki4, Kazuo Kimura5, Satoru Suwa6, Kazuteru Fujimoto7, Yasuharu Nakama8, Takashi Morita9, Wataru Shimizu10, Yoshihiko Saito11, Atsushi Hirohata12, Yasuhiro Morita13, Teruo Inoue14, Atsunori Okamura15, Masaaki Uematsu16, Junya Ako17, Michikazu Nakai18, Kunihiro Nishimura18, Yoshihiro Miyamoto18. 1. 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. 2. Division of Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan. Electronic address: ma-ishihara@hyo-med.ac.jp. 3. Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan. 4. Department of Cardiology, Fujita Health University, Toyoake, Japan. 5. Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan. 6. Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan. 7. Department of Cardiology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan. 8. Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan. 9. Division of Cardiology, Osaka General Medical Center, Osaka, Japan. 10. Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan. 11. First Department of Internal Medicine, Nara Medical University, Kashihara, Japan. 12. Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan. 13. Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan. 14. Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi, Japan. 15. Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan. 16. Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan. 17. Department of Cardiovascular Medicine, Kitasato University, Tokyo, Japan. 18. Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan.
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.
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.