Absence of chest pain a red flag for complications, increased mortality in AMI patients
The absence of the classical symptom of chest pain in patients with acute myocardial infarction (AMI) appears to be associated with more complications and higher short- and long-term mortality rates, particularly in younger and healthier patients, according to a study.
Researchers examined a cohort of 172,981 AMI patients (33.5 percent female) registered in the SWEDEHEART registry with available data on symptom presentation. The majority of patients presented with chest pain (92.9 percent in the <65 years age group; 84.4 percent in the ≥65 years age group). Patients presenting without vs with chest pain were older, more likely to be women, and have more comorbidities, prior medications and complications during hospitalization.
In the <65 years age group, patients without chest pain also had higher short- (30-day mortality: 945 vs 236 per 1,000 person-years) and long-term mortality rates (5-year mortality: 83 vs 21 per 1,000 person-years in patients <65 years. In the ≥65 years age group, the respective 30-day and 5-year mortality rates were 2,294 vs 1,140 per 1,000 person-years and 259 vs 109 per 1,000 person-years.
Multivariable Cox analysis showed the absence of chest pain to be associated with an increased risk of 5-year mortality (hazard ratio, 1.85; 95 percent CI, 1.81–1.89). The effect more pronounced in younger patients, as well as in those without prior AMI, heart failure, stroke, diabetes or hypertension.
In light of the findings, researchers pointed out a need to have greater awareness in identifying patients with AMI, despite an absence of symptom, as well as more intense treatment in the acute phase, during hospitalization and at discharge for these patients.
The current study was limited to variables that have been consistent and uniformly recorded since the start of the register, potentially leading to an underestimation of the risk of mortality in patients presenting without chest pain.