Risk Factors Related to the 7-Year Prognosis for Patients Suspected of Myocardial Infarction with and without Confirmed Diagnosis

Abstract

This study prospectively evaluates the long-term prognosis of patients admitted with chest pain under suspicion of acute myocardial infarction (AMI) with and without confirmed diagnosis. All patients below 76 years of age, free of other severe diseases and alive at discharge, who were admitted to a coronary care unit of a well-defined region during 1 year, constituted the study population. In all, 275 patients with and 257 patients without confirmed AMI (non-AMI) were included. During 7 years of follow-up, 122 cardiac events (96 cardiac deaths and 26 nonfatal AMI) occurred in the AMI patients, and 69 (44 cardiac deaths and 25 nonfatal AMI) were observed in the non-AMI patients. Using univariate analysis, the following risk variables were significantly related to an impaired prognosis of non-AMI patients: age, a history of previous AMI, angina pectoris, clinical heart failure, diabetes and ST or T changes in the electrocardiogram (ECG) on admission. By multivariate analysis, the following risk factors contained independent prognostic information for non-AMI patients: (1) a history of angina pectoris and (2) ST and T changes on the ECG on admission. We conclude that a subset of non-AMI patients at high risk for cardiac events even in the long term can be identified from the medical history and the ECG on admission. These patients should be carefully evaluated prior to discharge, whereas patients without signs of ischemic heart disease have an excellent prognosis.

Ten-Year Mortality of Patients Admitted to Coronary Care Units with and without Myocardial Infarction

“…The risk factors for AMI patients, age, pre vious AMI, clinical heart failure and diabetes, correspond to previous findings [ 10,15]. In this study with a large study population, a history of angina pectoris was shown to contain indepen dent prognostic information too (table 2).…”

“…How ever, the study suggested that the prognosis of non-AMI patients was very similar to that of patients with AMI. Now it is well documented that both the short-and the long-term prog noses are impaired among the subset of non-AMI patients who have coronary artery dis ease [4,5,10,11,19], whereas patients with out signs of coronary artery disease at exercise test or thallium scintigraphy have an excellent long-term prognosis [24,25], Consequently, all non-AMI patients should now undergo careful evaluation regarding coronary artery disease at the time of discharge in order to be able to optimize the risk stratification, treat ment and follow-up of high-risk patients. 265 …”

“…angina pectoris, previous AMI, ST-T changes in the ECG on admission [4,5], Studies observing non-AMI patients for more than 2 years are few and some indicate that both patients with and without signs of coronary artery disease are at increased risk for mortal events [6][7][8][9]. However, we recently demonstrated that both ST-T changes in the ECG on admission and a medical history of angina pectoris contained independent prog nostic information in the long term [10].…”

Long-Term Cardiac Mortality in Patients Admitted with Noncoronary Chest Pain under Suspicion of Acute Myocardial Infarction

“…However, risk stratification was not per formed. and we recently reported that both a history of angina pectoris and ST-T changes in the ECG on admission contained indepen dent prognostic information on long-term prognosis [14], Only few of the patients with noncoronary chest pain had a history of angina pectoris (8%) or previous AMI (7%). In spite of this, the cardiac mortality was almost twice as high as in the patients with coronary chest pain (32 vs. 17%).…”

Long-Term Risk of Death, Cardiac Events and Recurrent Chest Pain in Patients with Acute Chest Pain of Different Origin

“…The cardiac event rate is almost as high as in patients with confirmed infarction (AMI) and significantly higher than in the background population for up to 10 years after discharge [5,6], The short-and long-term risk has been shown to be KARGER closely associated with signs of ischemic heart disease (IHD) identified from the medical history [2,6], the ECG on admission [2,6. 7] or from an exercise test and/or myo cardial scintigraphy [7.…”