Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain
Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain
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DOI：
10.1001/jama.283.24.3223
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发表时间：
2000-06-28
影响因子：
120.7
通讯作者：
Kiefe, CI
中科院分区：
文献类型：
--
作者：
Canto, JG;Shlipak, MG;Kiefe, CI
背景：虽然胸痛被广泛认为是诊断心肌梗死(MI)的关键症状，但并不是所有的MI患者都有胸痛。目的确定无胸痛的心肌梗死患者出现的频率，并检查他们随后的治疗和结果。设计前瞻性观察性研究。设置和患者1994年6月至1998年3月在全国心肌梗死2登记处登记的434 877名患者，包括美国的1674家医院。主要结果衡量无胸痛的发生率；无胸痛的心肌梗死患者与有胸痛的患者的临床特征、治疗和死亡率，结果所有被诊断为有心肌梗死的患者中，142 445(33%)在就诊时没有胸痛。这组MI患者平均年龄比胸痛患者(74.2比66.9岁)大7岁，其中女性(49.0%比38.0%)、糖尿病患者(32.6%比25.4%)或既往心力衰竭患者(26.4%比12.3%)比例更高。此外，无胸痛的MI患者在入院前延迟(平均7.9vs5.3小时)，入院时被诊断为MI的可能性较小(22.2%vs50.3%)，接受溶栓或直接血管成形术(25.3%vs74.0%)、阿司匹林(60.4%vs84.5%)、β-受体阻滞剂(28.0%vs48.0%)或肝素(53.4%vs83.2%)的可能性较小。没有胸痛的心肌梗死患者的住院死亡率为23.3%，而有胸痛的患者的住院死亡率为9.3%(调整后的死亡率优势比为2.21[95%可信区间，2.17-2.26])。结论我们的结果表明，无胸痛的心肌梗死患者占心肌梗死人群的很大一部分，他们延迟就医、不那么激进的治疗和住院死亡率的风险更高。
Context Although chest pain is widely considered a key symptom in the diagnosis of myocardial infarction (MI), not all patients with MI present with chest pain. The extent to which this phenomenon occurs is largely unknown.Objectives To determine the frequency with which patients with MI present without chest pain and to examine their subsequent management and outcome.Design Prospective observational study.Setting and Patients A total of 434 877 patients with confirmed MI enrolled June 1994 to March 1998 in the National Registry of Myocardial Infarction 2, which includes 1674 hospitals in the United States.Main Outcome Measures Prevalence of presentation without chest pain; clinical characteristics, treatment, and mortality among MI patients without chest pain vs those with chest pain,Results Of all patients diagnosed as having MI, 142 445 (33%) did not have chest pain on presentation to the hospital. This group of MI patients was, on average, 7 years older than those with chest pain (74.2 vs 66.9 years), with a higher proportion of women (49.0% vs 38.0%) and patients with diabetes mellitus (32.6% vs 25.4%) or prior heart failure (26.4% vs 12.3%). Also, MI patients without chest pain had a longer delay before hospital presentation (mean, 7.9 vs 5.3 hours), were less likely to be diagnosed as having confirmed MI at the time of admission (22.2% vs 50.3%), and were less likely to receive thrombolysis or primary angioplasty (25.3% vs 74.0%), aspirin (60.4% vs 84.5%), beta-blockers (28.0% vs 48.0%), or heparin (53.4% vs 83.2%). Myocardial infarction patients without chest pain had a 23.3% in-hospital mortality rate compared with 9.3% among patients with chest pain (adjusted odds ratio for mortality, 2.21 [95% confidence interval, 2.17-2.26]).Conclusions Our results suggest that patients without chest pain on presentation represent a large segment of the MI population and are at increased risk for delays in seeking medical attention, less aggressive treatments, and in-hospital mortality.