Symptomatic myocardial infarction without chest pain: Prevalence and clinical course

Uretsky, Barry F.; Farquhar, Donald S.; Berezin, Andrew F.; Hood, William B.

doi:10.1016/0002-9149(77)90062-5

Cited by 123 publications

(41 citation statements)

References 22 publications

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“…The silent presentation of myocardial infarction is associated with an unfavorable prognosis. 3,4) One recent report found that patients without chest pain at the time of presentation with AMI failed to receive beneficial treatment and had higher rates of in-hospital death than those with chest pain. 8) However, there have been few studies on this topic in Japan.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Because the number of aged AMI patients who present without chest pain is growing, 5,6) it would be valuable to determine what in-hospital cardiac management such patients receive and to see whether the in-hospital outcomes for these patients are disappointing. Despite the importance of this subject, the impact of the lack of chest pain among AMI patients on in-hospital outcomes has not been studied widely, particularly in Japan.…”

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

et al. 2006

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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)

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

et al. 2006

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“…[1][2][3][4][5][6][7] These can help in assessing a patient's likelihood of AMI, but their predictive value may differ for certain subgroups of patients. 4,[8][9][10] In particular, gender may significantly affect the likelihood of AMI in ED patients with chest pain or other symptoms of acute cardiac ischemia.The incidence of AMI in the general population has been shown to be higher in men than women, 11-14 but it is not clear whether this gender difference holds among symptomatic patients who come to the ED. Knowing whether gender influences the likelihood that a given ED patient is having an AMI and whether any specific presenting signs and symptoms are differentially associated with AMI in women as compared with men could aid ED physicians in the accurate diagnosis of AMI.…”

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confidence: 99%

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Presentations of Acute Myocardial Infarction in Men and Women

et al. 1997

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OBJECTIVE:To assess the influence of gender on the likelihood of acute myocardial infarction (AMI) among emergency department (ED) patients with symptoms suggestive of acute cardiac ischemia, and to determine whether any specific presenting signs or symptoms are associated more strongly with AMI in women than in men. DESIGN:Analysis of cohort data from a prospective clinical trial. SETTING:Emergency departments of 10 hospitals of varying sizes and types in the United States. PATIENTS:Patients 30 years of age or older ( n ‫؍‬ 10,525) who presented to the ED with chest pain or other symptoms suggestive of acute cardiac ischemia. MEASUREMENTS AND MAIN RESULTS:The prevalence of AMI was determined for men and women, and a multivariable logistic regression model predicting AMI was developed to adjust for patients' demographic and clinical characteristics. AMI was almost twice as common in men as in women (10% vs 6%). Controlling for demographics, presenting signs and symptoms, electrocardiogram features, and hospital, male gender was a significant predictor of AMI (odds ratio [OR] 1.7; 95% confidence interval [CI] 1.4, 2.0). The gender effect was eliminated, however, among patients with ST-segment elevations on electrocardiogram (OR 1.1; 95% CI 0.7, 1.7) and among patients with signs of congestive heart failure (CHF) (OR 1.1; 95% CI 0.8, 1.5). Signs of CHF were associated with AMI among women (OR 1.9; 95% CI 1.4, 2.6) but not men (OR 1.0; 95% CI 0.8, 1.3). Among patients who presented to EDs with chest pain or other symptoms suggestive of acute cardiac ischemia, AMI was more likely in men than in women. Among women with ST-segment elevation or signs of CHF, however, AMI likelihood was similar to that in men with these characteristics. he benefits of time-dependent therapeutic interventions for acute myocardial infarction (AMI) depend on prompt and accurate diagnosis of AMI by emergency department (ED) physicians. As aids to rapid identification, risk factors, presenting characteristics, and diagnostic test results have been related to the occurrence of AMIs. [1][2][3][4][5][6][7] These can help in assessing a patient's likelihood of AMI, but their predictive value may differ for certain subgroups of patients. 4,[8][9][10] In particular, gender may significantly affect the likelihood of AMI in ED patients with chest pain or other symptoms of acute cardiac ischemia.The incidence of AMI in the general population has been shown to be higher in men than women, 11-14 but it is not clear whether this gender difference holds among symptomatic patients who come to the ED. Knowing whether gender influences the likelihood that a given ED patient is having an AMI and whether any specific presenting signs and symptoms are differentially associated with AMI in women as compared with men could aid ED physicians in the accurate diagnosis of AMI.Several studies have looked at gender differences in the presentation of patients with AMI. [15][16][17][18][19] In a retrospective analysis of patients with confirmed AMI, women had higher ra...

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“…Approximately 25% of myocardial infarcts are unrecognized either because mild symptoms are ignored by the patient or because no symptoms occurred (Margolis et al 1973). Atypical presentations of acute myocardial infarction commonly include acute dyspnoea or congestive cardiac failure -either newly developing or a worsening of established failure (Bean 1977, Uretsky et al 1977) -symptoms which could easily be attributed to the progression of valvular heart disease or infective endocarditis if the possibility of coronary embolic infarction were not considered in these conditions. Patients with coronary embolism may have a history of other systemic emboli (Charles et al 1982) since the underlying conditions are those which predispose to systemic embolism as a whole.…”

Section: Causes Of Coronary Embolismmentioning

confidence: 99%

Diagnosis of Coronary Embolism: A Review¹

Charles

Epstein

1983

J R Soc Med

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Coronary embolism is an uncommon but distinct clinical entity. It can be diagnosed clinically, and should be suspected when acute myocardial infarction occurs in association with an underlying condition which predisposes to embolism. The most common are valvular heart disease, a prosthetic heart valve, infective endocarditis, cardiomyopathy with mural thrombus and arrhythmia. The diagnosis may be obscured by atypical symptoms and transient ECG changes. The diagnosis is supported by the demonstration of normal coronary arteries by selective coronary arteriography. Treatment with long-term anticoagulants may prevent further emboli. Additional antiplatelet drugs are also necessary in patients with prosthetic heart valves.

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Symptomatic myocardial infarction without chest pain: Prevalence and clinical course

Cited by 123 publications

References 22 publications

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

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

Presentations of Acute Myocardial Infarction in Men and Women

Diagnosis of Coronary Embolism: A Review¹

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Symptomatic myocardial infarction without chest pain: Prevalence and clinical course

Cited by 123 publications

References 22 publications

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

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

Presentations of Acute Myocardial Infarction in Men and Women

Diagnosis of Coronary Embolism: A Review1

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Diagnosis of Coronary Embolism: A Review¹