Impact of symptom presentation on in-hospital outcomes in patients with acute myocardial infarction

on behalf of the J-MINUET Investigators

Research output: Contribution to journalArticle

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Abstract

Background Limited data exist regarding the association between symptom presentation of acute myocardial infarction (AMI) and in-hospital outcomes. Methods We analyzed data of the Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET). This was a prospective and multicenter registry consisting of 3085 AMI patients with available data of symptoms, who were hospitalized within 48 h from onset during July 2012 to March 2014. We defined typical symptoms as any of chest pain or pressure due to myocardial ischemia. Results Of this study population, 642 patients (20.8%) had atypical symptoms (atypical group) and the remaining 2443 patients (79.2%) showed typical symptoms (typical group). Compared to the typical group, the atypical group was associated with higher age, more females, hypertension, diabetes, chronic kidney disease, history of cardiovascular disease, non-ST elevation MI, and Killip class ≥2. In the atypical group, urgent percutaneous coronary intervention was less frequently performed than in the typical group, and in STEMI patients door-to-balloon time was longer in the atypical than typical group. Atypical group had larger infarct size than typical group. Furthermore, in-hospital mortality was significantly higher in atypical than in typical group (19.5% vs. 3.3%, p < 0.001). In multivariable analysis, presence of atypical symptoms was an independent predictor of in-hospital mortality (odds ratio 3.12, 95% confidence interval 2.19 to 4.47, p < 0.001). Moreover, the association between atypical symptoms and mortality was consistent across each subgroup. Conclusions Atypical symptoms of AMI were associated with less invasive therapy and poor outcome. Attention should be directed to these high-risk patients.

Original languageEnglish
Pages (from-to)29-34
Number of pages6
JournalJournal of cardiology
Volume70
Issue number1
DOIs
Publication statusPublished - 01-07-2017

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Myocardial Infarction
Hospital Mortality
Registries
Percutaneous Coronary Intervention
Chest Pain
Chronic Renal Insufficiency
Myocardial Ischemia
Cardiovascular Diseases
Odds Ratio
Confidence Intervals
Hypertension
Pressure
Mortality
Population
Therapeutics

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

on behalf of the J-MINUET Investigators. / Impact of symptom presentation on in-hospital outcomes in patients with acute myocardial infarction. In: Journal of cardiology. 2017 ; Vol. 70, No. 1. pp. 29-34.
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abstract = "Background Limited data exist regarding the association between symptom presentation of acute myocardial infarction (AMI) and in-hospital outcomes. Methods We analyzed data of the Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET). This was a prospective and multicenter registry consisting of 3085 AMI patients with available data of symptoms, who were hospitalized within 48 h from onset during July 2012 to March 2014. We defined typical symptoms as any of chest pain or pressure due to myocardial ischemia. Results Of this study population, 642 patients (20.8{\%}) had atypical symptoms (atypical group) and the remaining 2443 patients (79.2{\%}) showed typical symptoms (typical group). Compared to the typical group, the atypical group was associated with higher age, more females, hypertension, diabetes, chronic kidney disease, history of cardiovascular disease, non-ST elevation MI, and Killip class ≥2. In the atypical group, urgent percutaneous coronary intervention was less frequently performed than in the typical group, and in STEMI patients door-to-balloon time was longer in the atypical than typical group. Atypical group had larger infarct size than typical group. Furthermore, in-hospital mortality was significantly higher in atypical than in typical group (19.5{\%} vs. 3.3{\%}, p < 0.001). In multivariable analysis, presence of atypical symptoms was an independent predictor of in-hospital mortality (odds ratio 3.12, 95{\%} confidence interval 2.19 to 4.47, p < 0.001). Moreover, the association between atypical symptoms and mortality was consistent across each subgroup. Conclusions Atypical symptoms of AMI were associated with less invasive therapy and poor outcome. Attention should be directed to these high-risk patients.",
author = "{on behalf of the J-MINUET Investigators} and Masashi Fujino and Masaharu Ishihara and Hisao Ogawa and Koichi Nakao and Satoshi Yasuda and Teruo Noguchi and Yukio Ozaki and Kazuo Kimura and Satoru Suwa and Kazuteru Fujimoto and Yasuharu Nakama and Takashi Morita and Wataru Shimizu and Yoshihiko Saito and Atsushi Hirohata and Yasuhiro Morita and Teruo Inoue and Atsunori Okamura and Masaaki Uematsu and Junya Ako and Michikazu Nakai and Kunihiro Nishimura and Yoshihiro Miyamoto",
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Impact of symptom presentation on in-hospital outcomes in patients with acute myocardial infarction. / on behalf of the J-MINUET Investigators.

In: Journal of cardiology, Vol. 70, No. 1, 01.07.2017, p. 29-34.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of symptom presentation on in-hospital outcomes in patients with acute myocardial infarction

AU - on behalf of the J-MINUET Investigators

AU - Fujino, Masashi

AU - Ishihara, Masaharu

AU - Ogawa, Hisao

AU - Nakao, Koichi

AU - Yasuda, Satoshi

AU - Noguchi, Teruo

AU - Ozaki, Yukio

AU - Kimura, Kazuo

AU - Suwa, Satoru

AU - Fujimoto, Kazuteru

AU - Nakama, Yasuharu

AU - Morita, Takashi

AU - Shimizu, Wataru

AU - Saito, Yoshihiko

AU - Hirohata, Atsushi

AU - Morita, Yasuhiro

AU - Inoue, Teruo

AU - Okamura, Atsunori

AU - Uematsu, Masaaki

AU - Ako, Junya

AU - Nakai, Michikazu

AU - Nishimura, Kunihiro

AU - Miyamoto, Yoshihiro

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Background Limited data exist regarding the association between symptom presentation of acute myocardial infarction (AMI) and in-hospital outcomes. Methods We analyzed data of the Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET). This was a prospective and multicenter registry consisting of 3085 AMI patients with available data of symptoms, who were hospitalized within 48 h from onset during July 2012 to March 2014. We defined typical symptoms as any of chest pain or pressure due to myocardial ischemia. Results Of this study population, 642 patients (20.8%) had atypical symptoms (atypical group) and the remaining 2443 patients (79.2%) showed typical symptoms (typical group). Compared to the typical group, the atypical group was associated with higher age, more females, hypertension, diabetes, chronic kidney disease, history of cardiovascular disease, non-ST elevation MI, and Killip class ≥2. In the atypical group, urgent percutaneous coronary intervention was less frequently performed than in the typical group, and in STEMI patients door-to-balloon time was longer in the atypical than typical group. Atypical group had larger infarct size than typical group. Furthermore, in-hospital mortality was significantly higher in atypical than in typical group (19.5% vs. 3.3%, p < 0.001). In multivariable analysis, presence of atypical symptoms was an independent predictor of in-hospital mortality (odds ratio 3.12, 95% confidence interval 2.19 to 4.47, p < 0.001). Moreover, the association between atypical symptoms and mortality was consistent across each subgroup. Conclusions Atypical symptoms of AMI were associated with less invasive therapy and poor outcome. Attention should be directed to these high-risk patients.

AB - Background Limited data exist regarding the association between symptom presentation of acute myocardial infarction (AMI) and in-hospital outcomes. Methods We analyzed data of the Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET). This was a prospective and multicenter registry consisting of 3085 AMI patients with available data of symptoms, who were hospitalized within 48 h from onset during July 2012 to March 2014. We defined typical symptoms as any of chest pain or pressure due to myocardial ischemia. Results Of this study population, 642 patients (20.8%) had atypical symptoms (atypical group) and the remaining 2443 patients (79.2%) showed typical symptoms (typical group). Compared to the typical group, the atypical group was associated with higher age, more females, hypertension, diabetes, chronic kidney disease, history of cardiovascular disease, non-ST elevation MI, and Killip class ≥2. In the atypical group, urgent percutaneous coronary intervention was less frequently performed than in the typical group, and in STEMI patients door-to-balloon time was longer in the atypical than typical group. Atypical group had larger infarct size than typical group. Furthermore, in-hospital mortality was significantly higher in atypical than in typical group (19.5% vs. 3.3%, p < 0.001). In multivariable analysis, presence of atypical symptoms was an independent predictor of in-hospital mortality (odds ratio 3.12, 95% confidence interval 2.19 to 4.47, p < 0.001). Moreover, the association between atypical symptoms and mortality was consistent across each subgroup. Conclusions Atypical symptoms of AMI were associated with less invasive therapy and poor outcome. Attention should be directed to these high-risk patients.

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DO - 10.1016/j.jjcc.2016.10.002

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