Clinical InvestigationAcute Ischemic Heart DiseaseDifferences in symptom presentation and hospital mortality according to type of acute myocardial infarction
Section snippets
Patient population and data collection
The NRMI was funded by Genentech, Inc, and represents the largest registry of its kind in the world, which has enrolled 2,160,671 patients admitted with MI at 1,977 hospitals from 1994 to 2006. In the NRMI, the diagnosis of acute MI was based on a clinical presentation consistent with acute MI at the time of hospitalization and was determined by each local hospital. This primarily involved an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code of
Study population
A total of 1,143,513 patients with MI were eligible. The average age was 69.6 years, and 42% were female. About half of our study population presented with STEMI (n = 565,195) and the other half with NSTEMI (n = 578,314). Among patients with STEMI, more than one fourth presented without chest pain/discomfort (Figure 1). In patients with NSTEMI, more than two fifths presented without chest pain/discomfort.
Baseline and presenting characteristics
Patients with STEMI and chest pain/discomfort were, on average, younger than those without
Discussion
We present the largest study to date examining atypical presentation by classification of MI type and associated hospital mortality. Among patients with STEMI, just more than one fourth presented without chest pain/discomfort compared with more than two fifths of patients with NSTEMI. In an adjusted model accounting for sociodemographics, coronary heart disease risk factors, and medical history, patients with NSTEMI had almost twice the odds compared with patients with STEMI of having MI
Conclusions
Hospitalized patients with NSTEMI were almost 2-fold more likely to present without chest pain/discomfort than patients with STEMI. In both STEMI and NSTEMI, patients without chest pain/discomfort received fewer guideline-based potentially lifesaving interventions upon hospitalization and had significantly higher crude and adjusted mortality than patients with chest pain/discomfort. More than one-quarter of patients with STEMI presented with atypical symptoms. Because patients with STEMI are
Disclosures
Paul D. Frederick is an employee of ICON, a contract research organization that receives research funding from the pharmaceutical industry. He was paid by Genentech, Inc, to provide biostatistical and analytic services. George Sopko is an employee of the Health and Human Services, National Institutes of Health, and National Heart, Lung, and Blood Institute, and the material presented should not be taken as representing the viewpoint of these organizations.
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Cited by (0)
Catarina Kiefe reports receiving partial funding from the National Institutes of Health (grants U01HL 105268 and U54 RR 026088).
- k
For the NRMI Investigators.