TY - JOUR
T1 - Comparison of outcomes of patients with painless versus painful ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention
AU - Cho, Jae Yeong
AU - Jeong, Myung Ho
AU - Ahn, Young Keun
AU - Kim, Jong Hyun
AU - Chae, Shung Chull
AU - Kim, Young Jo
AU - Hur, Seung Ho
AU - Seong, In Whan
AU - Hong, Taek Jong
AU - Choi, Dong Hoon
AU - Cho, Myeong Chan
AU - Kim, Chong Jin
AU - Seung, Ki Bae
AU - Chung, Wook Sung
AU - Jang, Yang Soo
AU - Cho, Seung Yun
AU - Rha, Seung Woon
AU - Bae, Jang Ho
AU - Cho, Jeong Gwan
AU - Park, Seung Jung
N1 - Funding Information:
This study was supported by a grant from the Korean Society of Circulation , Seoul, Republic of Korea, in celebration of its 50th Anniversary and the Korea Healthcare Technology R&D Project ( A084869 ), Ministry for Health, Welfare and Family Affairs , Seoul, Republic of Korea, and the Cardiovascular Research Foundation Asia , Seoul, Republic of Korea.
PY - 2012/2/1
Y1 - 2012/2/1
N2 - There are few data available on the prognosis of painless ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine the incidence, clinical characteristics, and outcomes of painless STEMI. We analyzed the Korea Acute Myocardial Infarction Registry (KAMIR) study, which enrolled 7,288 patients with STEMI (61.8 ± 12.8 years old, 74% men; painless STEMI group, n = 763; painful STEMI group, n = 6,525). End points were in-hospital mortality and 1-year major adverse cardiac events (MACEs). Patients with painless STEMI were older and more likely to be women, nonsmokers, diabetic, and normolipidemic and to have a higher Killip class. The painless group had more in-hospital deaths (5.9% vs 3.6%, p = 0.026) and 1-year MACEs (26% vs 19%, p = 0.002). In Cox proportional hazards analysis, hypotension (hazard ratio [HR] 4.40, 95% confidence interval [CI] 1.41 to 13.78, p = 0.011), low left ventricular ejection fraction (HR 3.12, 95% CI 1.21 to 8.07, p = 0.019), and a high Killip class (HR 3.48, 95% CI 1.19 to 10.22, p = 0.023) were independent predictors of 1-year MACEs in patients with painless STEMI. In conclusion, painless STEMI was associated with more adverse outcomes than painful STEMI and late detection may have contributed significantly to total ischemic burden. These results warrant more investigations for methodologic development in the diagnosis of silent ischemia and painless STEMI.
AB - There are few data available on the prognosis of painless ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine the incidence, clinical characteristics, and outcomes of painless STEMI. We analyzed the Korea Acute Myocardial Infarction Registry (KAMIR) study, which enrolled 7,288 patients with STEMI (61.8 ± 12.8 years old, 74% men; painless STEMI group, n = 763; painful STEMI group, n = 6,525). End points were in-hospital mortality and 1-year major adverse cardiac events (MACEs). Patients with painless STEMI were older and more likely to be women, nonsmokers, diabetic, and normolipidemic and to have a higher Killip class. The painless group had more in-hospital deaths (5.9% vs 3.6%, p = 0.026) and 1-year MACEs (26% vs 19%, p = 0.002). In Cox proportional hazards analysis, hypotension (hazard ratio [HR] 4.40, 95% confidence interval [CI] 1.41 to 13.78, p = 0.011), low left ventricular ejection fraction (HR 3.12, 95% CI 1.21 to 8.07, p = 0.019), and a high Killip class (HR 3.48, 95% CI 1.19 to 10.22, p = 0.023) were independent predictors of 1-year MACEs in patients with painless STEMI. In conclusion, painless STEMI was associated with more adverse outcomes than painful STEMI and late detection may have contributed significantly to total ischemic burden. These results warrant more investigations for methodologic development in the diagnosis of silent ischemia and painless STEMI.
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U2 - 10.1016/j.amjcard.2011.09.017
DO - 10.1016/j.amjcard.2011.09.017
M3 - Article
C2 - 22088201
AN - SCOPUS:84855974104
SN - 0002-9149
VL - 109
SP - 337
EP - 343
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 3
ER -
