Comparison of risk factors between different groups at baseline was assessed by the χ 2 test for dichotomous variables and the t-test for mean values, as well as the Wilcoxon rank test for medians of continuous variables. Descriptive statistics mean and SD, median and IQR and percentages are used to describe baseline characteristics.
#Does all my patients all have chest pain software#
For anonymity, all personal identifiers were removed and replaced with a code in the final data set.Īll analyses and data management were performed using the statistical software SAS V.9.3 (SAS Institute, Cary, North Carolina, USA). Data regarding all-cause mortality were obtained by merging SWEDEHEART with the National Cause of Death register. The Swedish IPR is based on the International Classification of Diseases (ICD) codes, with the ICD ninth revision used from 1987 to 1997 and the ICD 10th revision from 1997 to 2010. Data for the remaining baseline variables were collected from SWEDEHEART. By merging the Swedish National Inpatient Register (IPR) with SWEDEHEART, prior events or a history of diabetes, hypertension, heart failure, stroke, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) were identified. After these exclusions, the study population comprised 172 981 unique patients diagnosed with AMI. Patients with missing information on symptom presentation (n=19 422, 10.0%), prehospital CPR (n=2158, 1.12%) or invalid PIN codes (n=48, 0.025%) were excluded from the study.
Patients presenting with dyspnoea or other symptoms was defined as not having chest pain. In the protocol, symptom presentation at the time of admission was registered as (1) chest pain, (2) dyspnoea, (3) prehospital cardiopulmonary resuscitation (CPR) or (4) other symptoms (not specified). We included patients the first time that they appeared in the register, and a total of 194 609 patients were identified. This study included all patients aged 18 to 84 years in the SWEDEHEART registry, who were admitted to hospital because of AMI between 19. 19 20 Tobacco smoking status was defined as not smoking (never smoked), ex-smoker (>1 month before admission to hospital) and current smoker. 14 Therefore, this study aimed to investigate long-term mortality in patients who were hospitalised with AMI presenting with or without chest pain.ĭuring the study period, Sweden adhered to the criteria for diagnosis of AMI according to WHO (1996 to 2001) 18 Additionally, criteria were based on the European Society of Cardiology and American College of Cardiology Committee/American Heart Association consensus document from 2001 when the use of troponins became standard.
13 However, whether this poorer outcome is sustained throughout the first year has only been shown in a small study. Patients with AMI without chest pain have a higher short-term mortality rate compared with patients presenting with chest pain.
5 8 Potentially because of this, complications are more prevalent in patients with AMI presenting without chest pain or discomfort than in those with these symptoms. 7 Therefore, these patients are more frequently misdiagnosed 5 16 and receive less aggressive medical treatments and interventions. Patients with AMI presenting without chest pain have a longer delay before they seek medical attention and hospital presentation. 9–12 Moreover, atypical symptoms of AMI are associated with significantly higher mortality 5 13–15 for reasons that are not entirely clear. 8 Patients with AMI with insidious, vague or atypical symptoms have difficulties in interpreting and acknowledging bodily symptoms. 1–5 Absence of chest pain in AMI is more common in patients with a history of diabetes, in women, older patients 6 7 and in patients with non ST-segment-elevation myocardial infarction (non-STEMI). Previous studies have shown that between 10% and 40% of patients with AMI do not report chest pain. Most patients with acute myocardial infarction (AMI) present with chest pain, 1 but presenting without classical symptoms is not uncommon.
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