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Coronary artery disease
Original research article
Absence of chest pain and long-term mortality in patients with acute myocardial infarction
  1. Lena Björck1,2,
  2. Susanne Nielsen1,
  3. Tomas Jernberg3,
  4. Tatiana Zverkova-Sandström1,
  5. Kok Wai Giang1 and
  6. Annika Rosengren1,2
  1. 1 Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  2. 2 Department of Medicine, Sahgrenska University Hospital/Östra Sjukhuset, Gothenburg, Sweden
  3. 3 Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Lena Björck; lena.bjorck{at}gu.se

Abstract

Objective Chest pain is the predominant symptom in patients with acute myocardial infarction (AMI). A lack of chest pain in patients with AMI is associated with higher in-hospital mortality, but whether this outcome is sustained throughout the first years after onset is unknown. Therefore, we aimed to investigate long-term mortality in patients hospitalised with AMI presenting with or without chest pain.

Methods All AMI cases registered in the SWEDEHEART registry between 1996 and 2010 were included in the study. In total, we included 172 981 patients (33.5% women) with information on symptom presentation.

Results Patients presenting without chest pain (12.7%) were older, more often women and had more comorbidities, prior medications and complications during hospitalisation than patients with chest pain. Short-term and long-term mortality rates were higher in patients without chest pain than in patients with chest pain: 30-day mortality, 945 versus 236/1000 person-years; 5-year mortality, 83 versus 21/1000 person-years in patients <65 years. In patients ≥65 years, 30-day mortality was 2294 versus 1140/1000 person-years; 5-year mortality, 259 versus 109/1000 person-years. In multivariable analysis, presenting without chest pain was associated with an overall 5-year HR of 1.85 (95% CI 1.81 to 1.89), with a stronger effect in younger compared with older patients, as well as in patients without prior AMI, heart failure, stroke, diabetes or hypertension.

Conclusion Absence of chest pain in patients with AMI is associated with more complications and higher short-term and long-term mortality rates, particularly in younger patients, and in those without previous cardiovascular disease.

  • acute myocardial infarction
  • epidemiology
  • acute coronary syndromes
  • Mortality

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2018-000909

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    Footnotes

    • Contributors Substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of the data for the work: LB, SN, TJ, TZ-S, KWG, AR. Drafting of the work or revising it critically for important intellectual content: LB, SN, TJ, TZ-S, KWG, AR. Final approval of the version to be published: LB, SN, TJ, TZ-S, KWG, AR. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: LB, SN, TJ, TZ-S, KWG, AR.

    • Funding This study received grants from the Swedish State under the Agreement Concerning Research and Education of Doctors (ALFGBG-427301); the Swedish Heart and Lung Foundation (2015-0438); the Swedish Research Council (2013-5187 (SIMSAM), 2013-4236); and the Swedish Council for Health, Working Life and Welfare (FORTE) (Epilife).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The Uppsala University Hospital ethics committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data that we have acquired from a combination of registers cannot be shared, but they are accessible after relevant permissions from an ethics board and application to the registers in question.