Yonsei Med J.  2014 May;55(3):617-624. 10.3349/ymj.2014.55.3.617.

Performance of Reperfusion Therapy and Hospital Mortality in ST-Elevation Myocardial Infarction Patients with Non-Chest Pain Complaints

• Na JP
• Shin KC
• Kim S
• Park YS
• Chung SP
• Park IC
• Park JM
• Kim MJ

• KMID: 2068670
• DOI: http://doi.org/10.3349/ymj.2014.55.3.617

Abstract

PURPOSE
ST-elevation myocardial infarction (STEMI) patients may visit the emergency department (ED) complaining of sensations of pain other than the chest. We investigated our performance of reperfusion therapy for STEMI patients presenting with non-chest pains.
MATERIALS AND METHODS
This was a retrospective observational cohort study. STEMI patients who underwent primary percutaneous coronary intervention (PCI) were divided into a chest pain group and a non-chest pain group. Clinical differences between the two groups and the influence of presenting with non-chest pains on door-to-electrocardiograms (ECG) time, door-to-balloon time, and hospital mortality were evaluated.
RESULTS
Of the 513 patients diagnosed with STEMI, 93 patients presented with non-chest pains. Patients in the non-chest pain group were older, more often female, and had a longer symptom onset to ED arrival time and higher Killip class than patients in the chest pain group. There was a statistically significant delay in door-to-ECG time (median, 2.0 min vs. 5.0 min; p<0.001) and door-to-balloon time (median, 57.5 min vs. 65.0 min; p<0.001) in patients without chest pain. In multivariate analysis, presenting with non-chest pains was an independent predictor for hospital mortality (odds ratio, 2.3; 95% confidence interval, 1.1-4.7). However, door-to-ECG time and door-to-balloon time were not factors related to hospital mortality.
CONCLUSION
STEMI patients presenting without chest pain showed higher baseline risk and hospital mortality than patients presenting with chest pain. ECG acquisition and primary PCI was delayed for patients presenting with non-chest pains, but not influencing hospital mortality. Efforts to reduce pre-hospital time delay for these patients are necessary.

Keyword

Chest pain; electrocardiography; myocardial infarction; reperfusion

MeSH Terms

Aged
Aged, 80 and over
Chest Pain/*diagnosis
Electrocardiography
Female
Hospital Mortality
Humans
Male
Middle Aged
Myocardial Infarction/mortality/*surgery
Retrospective Studies

Figure

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  Fig. 1 Distribution and frequency of chief complaints.

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  Fig. 2 Proportion of patients who achieved the goal door-to-ECG time and door-to-balloon time. ECG, electrocardiogram.

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