Open AccessClinical outcomes according to symptom presentation in patients with acute myocardial infarction: Results from the FAST‐MI 2010 registry
Author(s) -
Puymirat Etienne,
Aissaoui Nadia,
Bonello Laurent,
Cayla Guillaume,
Labèque JeanNoel,
Nallet Olivier,
Motreff Pascal,
Varenne Olivier,
Schiele François,
Ferrières Jean,
Simon Tabassome,
Danchin Nicolas
Publication year - 2017
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22819
Subject(s) - medicine , chest pain , myocardial infarction , presentation (obstetrics) , cardiology , emergency department , demographics , surgery , demography , psychiatry , sociology
Background Atypical clinical presentation in acute myocardial infarction (AMI) patients is not uncommon; most studies suggest that it is associated with unfavorable prognosis. Hypothesis Long‐term clinical impact differs according to predominant symptom presentation (typical chest pain, atypical chest pain, syncope, cardiac arrest, or dyspnea) in AMI patients. Methods FAST‐MI 2010, a nationwide French registry, included 4169 patients with AMI in 213 centers at the end of 2010 (76% of active centers). Demographics, medical history, hospital management, and outcomes were compared according to predominant symptom presentation. Results Typical chest pain with no other symptom was reported in 3020 patients (68% in STEMI patients, 76% in NSTEMI patients). Atypical chest pain, dyspnea, syncope, and cardiac arrest were reported in 11%, 11%, 5%, and 1%, respectively. Patients with atypical clinical presentation had a higher cardiovascular risk profile and received fewer medications and a less invasive strategy. Using Cox multivariate analysis, atypical chest pain was not associated with higher death rate at 3 years (HR: 0.96, 95% CI: 0.69‐1.33, P = 0.78), whereas cardiac arrest (HR: 2.44, 95% CI: 1.00‐5.97, P = 0.05), syncope (HR: 1.70, 95% CI: 1.18‐2.46, P = 0.005), and dyspnea (HR: 1.66, 95% CI: 1.31‐2.10, P < 0.001) were associated with higher long‐term mortality compared with patients with typical isolated chest pain. Similar trends were observed in STEMI and NSTEMI populations. Conclusions Atypical clinical presentation is observed in about 20% of AMI patients. Cardiac arrest, dyspnea, and syncope represent independent predictors of long‐term mortality in STEMI and NSTEMI populations.