| Poor prognosis of patients presenting with symptomatic myocardial infarction but without chest pain. | |
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MedLine Citation:
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PMID: 11602537 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To describe the clinical features, prognosis, and treatment of patients presenting with atypical forms of acute myocardial infarction. DESIGN: Consecutive cases of possible acute myocardial infarction were sought from coronary care registers, biochemistry records, and hospital management systems. Case notes were reviewed and predefined epidemiological and clinical variables were abstracted. SETTING: 20 adjacent hospitals in the former Yorkshire region. PATIENTS: 3684 consecutive cases of possible acute myocardial infarction admitted in a three month period were identified, of whom 2096 had a first episode of confirmed acute myocardial infarction. RESULTS: 20.2% of all patients admitted with an eventual diagnosis of acute myocardial infarction presented with symptoms other than chest pain. Compared with the group presenting with chest pain, these patients were older (76.6 v 69.1 years, p < 0.001), were more often women (54.6% v 35.3%, p < 0.001), and were more likely to have a history of heart failure (18.6% v 6.9%, p < 0.001). They had a higher 30 and 365 day mortality (49.2% and 61.0%, respectively) compared with patients presenting with chest pain (17.9% and 26.2%). In a Cox regression analysis the hazard ratio for presentation without chest pain was 1.60 (95% confidence interval 1.30 to 1.97) (p < 0.001) adjusted for age, heart rate, blood pressure, left ventricular impairment, and infarction with ST segment elevation as covariates. Importantly, they were also less likely to receive treatments with a proven ability to improve prognosis. CONCLUSIONS: Atypical presentation of myocardial infarction without chest pain is common and associated with increased mortality. This may result in part from a failure to use beneficial treatment strategies. |
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Authors:
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M F Dorsch; R A Lawrance; R J Sapsford; N Durham; J Oldham; D C Greenwood; B M Jackson; C Morrell; M B Robinson; A S Hall; |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Heart (British Cardiac Society) Volume: 86 ISSN: 1468-201X ISO Abbreviation: Heart Publication Date: 2001 Nov |
Date Detail:
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Created Date: 2001-10-16 Completed Date: 2001-12-10 Revised Date: 2009-11-18 |
Medline Journal Info:
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Nlm Unique ID: 9602087 Medline TA: Heart Country: England |
Other Details:
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Languages: eng Pagination: 494-8 Citation Subset: AIM; IM |
Affiliation:
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BHF Heart Research Centre, Jubilee Wing, Leeds General Infirmary, Leeds LS2 9JT, UK. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Age Distribution Aged Blood Pressure / physiology Chest Pain / etiology*, mortality, physiopathology Female Heart Rate / physiology Humans Male Myocardial Infarction / mortality, physiopathology, therapy* Prognosis Regression Analysis Sex Distribution Survival Analysis |
| Comments/Corrections | |
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