Ontology type: schema:ScholarlyArticle Open Access: True
2019-06-05
AUTHORSJeremy Zhenwen Pong, Andrew Fu Wah Ho, Timothy Xin Zhong Tan, Huili Zheng, Pin Pin Pek, Ching-Hui Sia, Derek John Hausenloy, Marcus Eng Hock Ong
ABSTRACTST-segment elevation myocardial infarction (STEMI) often presents acutely at the Emergency Department (ED). Although chest pain is a classical symptom, a significant proportion of patients do not present with chest pain. The impact of a non-chest pain (NCP) presentation on ED processes-of-care and outcomes is not fully understood. We utilised a national registry to characterise predictors, processes-of-care, and outcomes of NCP STEMI presentations. Retrospective data for all STEMI cases occurring between 2010 and 2012 were analysed from the Singapore Myocardial Infarction Registry. Cases of inpatient onset, inter-facility transfers, and out-of-hospital cardiac arrests were excluded. Univariable analysis of demographic, clinical, processes-of-care, and outcome variables was conducted. Multivariable logistic regression ascertained independent predictors of a NCP presentation and 28-day mortality. Of 4667 STEMI cases, 12.9% presented without chest pain. Patients with NCP presentation were older (median, years = 74 vs. 58; p < 0.001), more likely to be female (39.1% vs. 15.7%; p < 0.001), of the Chinese race (72.5% vs. 62.7%; p < 0.001), and with diabetes (48.6% vs. 36.7%; p < 0.001). These patients were more likely to present with syncope (6.0% vs. 1.9%; p < 0.001) or epigastric pain (10.6% vs. 4.9%; p < 0.001). Patients with NCP presentation were less likely to receive percutaneous coronary intervention (27.0% vs. 75.6%; p < 0.001), had longer door-to-balloon time (median, minutes = 83 vs. 63; p < 0.001), and experienced greater mortality at 28 days (31.2% vs. 4.5%; p < 0.001). On multivariable logistic regression, independent predictors of a NCP presentation included age (adjusted odds ratio [aOR] = 1.05, 95% confidence interval [CI] 1.04–1.07), diabetes (aOR = 1.76, 95% CI 1.40–2.19), BMI (aOR = 0.93, 95% CI 0.91–0.96), and dyslipidemia (aOR = 0.73, 95% CI 0.58–0.91). Absence of chest pain was an independent predictor for 28-day mortality (aOR = 3.46, 95% CI 2.64–4.52). Patients who presented with a NCP STEMI had a distinct clinical profile and experienced poorer outcomes. Routine triage ECG could be considered for patients with high-risk factors and non-classical symptoms. More... »
PAGES989-997
http://scigraph.springernature.com/pub.10.1007/s11739-019-02122-3
DOIhttp://dx.doi.org/10.1007/s11739-019-02122-3
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| 75 | ″ | ″ | multivariable logistic regression |
| 76 | ″ | ″ | myocardial infarction |
| 77 | ″ | ″ | national registry |
| 78 | ″ | ″ | non-classical symptoms |
| 79 | ″ | ″ | onset |
| 80 | ″ | ″ | outcome variables |
| 81 | ″ | ″ | outcomes |
| 82 | ″ | ″ | pain |
| 83 | ″ | ″ | pain presentations |
| 84 | ″ | ″ | patients |
| 85 | ″ | ″ | percutaneous coronary intervention |
| 86 | ″ | ″ | poor outcome |
| 87 | ″ | ″ | predictors |
| 88 | ″ | ″ | presentation |
| 89 | ″ | ″ | process |
| 90 | ″ | ″ | profile |
| 91 | ″ | ″ | proportion |
| 92 | ″ | ″ | race |
| 93 | ″ | ″ | registry |
| 94 | ″ | ″ | regression |
| 95 | ″ | ″ | retrospective data |
| 96 | ″ | ″ | significant proportion |
| 97 | ″ | ″ | symptoms |
| 98 | ″ | ″ | syncope |
| 99 | ″ | ″ | time |
| 100 | ″ | ″ | transfer |
| 101 | ″ | ″ | triage ECG |
| 102 | ″ | ″ | univariable analysis |
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