Japanese Patients With Acute Myocardial Infarction Who Present Without Chest Pain A High-risk Group

Abstract

SUMMARYPrevious studies have suggested that patients with acute myocardial infarction (AMI) who presented without chest pain had an unfavorable prognosis due to undertreatment. Despite this, few studies have been conducted on the topic, particularly in Japan. The present analysis aimed at determining whether Japanese AMI patients without chest pain are undertreated and experience higher mortality during hospitalization. Data from the Tokai Acute Myocardial Infarction Study II sample were used, which is a prospective study of all consecutive patients admitted to the 15 acute care hospitals in the Tokai region with the diagnosis of AMI from 2001 to 2003. Data on baseline and procedural characteristics and hospital outcome were collected. Differences in the baseline and procedural characteristics and clinical outcomes between patients presenting with and without chest pain were assessed. We evaluated a total of 1769 patients who presented with chest pain and 452 who did not. The patients with AMI in the absence of chest pain were older and were more likely to have worse clinical conditions than those with chest pain. They were more likely to be undertreated, although the probability of vasopressor use was higher. The patients without chest pain had a significantly higher in-hospital mortality rate than those with chest pain. According to multivariate analysis, however, chest pain was not identified as an independent predictor of in-hospital death. The results suggest that the higher in-hospital mortality rate among Japanese AMI patients without chest pain could be accounted for by differences in clinical conditions. (Int Heart J 2006; 47: 483-490)

Characteristics and Outcomes of MI Patients with and without Chest Pain: A Cohort Study

“…We also found patients were less likely to have a cardiac procedure during their hospitalisation if they presented without chest pain. These findings are also consistent with the literature, patients without chest pain are less likely to undergo an angiogram [4,8,11,36] and PCI [4,6,8] during hospital admission.…”

“…[4,8,[10][11][12][13]26,27,36] However, after multivariable adjustment we did not find MI without chest pain was associated with survival. Two other studies [36,37] had similar results. One study, [36] only examined in-hospital survival.…”

“…Two other studies [36,37] had similar results. One study, [36] only examined in-hospital survival. The other longitudinal cohort study, [37] had a median follow-up of 5.4 years, however the inclusion criteria to identify individuals with unrecognised MI was self-report and the potential for recall bias was a limitation in this study.…”

“…[6,12,27,36] The Primary PCI activation criteria at SCGH includes symptom onset less than 12 hours, electrocardiogram (ECG) evidence of STEMI, less than 80 years, ongoing pain, and that the patient is mobile and independent. However, clinicians are informed that the activation criteria are not absolute and that patients who have typical ECG changes and other clinical features of MI (e.g.…”

Craniofacial Pain of Cardiac Origin Is Associated with Inferior Wall Ischemia

“…1 They are more often misdiagnosed, are less likely to receive appropriate therapy, and have, as a consequence, a higher risk of death. [1][2][3][4][5][6][7][8][9] One explanation for misdiagnosis is highlighted in previous findings that in patients with no chest pain during myocardial ischemia, craniofacial pain prevailed over pain occurring in other well-recognized referral sites, such as the arms or shoulders, and nearly half of these patients reported only craniofacial pain during the ischemic episode. 10 Since early recognition of this high-risk group should improve survival, there is a need for greater understanding of atypical symptom presentation during myocardial ischemia, including prodromal (preinfarction) angina.…”