Comparison of outcomes of patients with painless versus painful ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention

Jae Yeong Cho, Myung Ho Jeong, Young Keun Ahn, Jong Hyun Kim, Shung Chull Chae, Young Jo Kim, Seung Ho Hur, In Whan Seong, Taek Jong Hong, Donghoon Choi, Myeong Chan Cho, Chong Jin Kim, Ki Bae Seung, Wook Sung Chung, Yangsoo Jang, Seung Yun Cho, Seung Woon Rha, Jang Ho Bae, Jeong Gwan Cho, Seung Jung Park

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Pages (from-to)337-343
Number of pages7
JournalAmerican Journal of Cardiology
Volume109
Issue number3
DOIs
Publication statusPublished - 2012 Feb 1

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Percutaneous Coronary Intervention
Myocardial Infarction
Confidence Intervals
ST Elevation Myocardial Infarction
Korea
Hospital Mortality
Stroke Volume
Hypotension
Registries
Ischemia
Incidence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Cho, Jae Yeong ; Jeong, Myung Ho ; Ahn, Young Keun ; Kim, Jong Hyun ; Chae, Shung Chull ; Kim, Young Jo ; Hur, Seung Ho ; Seong, In Whan ; Hong, Taek Jong ; Choi, Donghoon ; Cho, Myeong Chan ; Kim, Chong Jin ; Seung, Ki Bae ; Chung, Wook Sung ; Jang, Yangsoo ; Cho, Seung Yun ; Rha, Seung Woon ; Bae, Jang Ho ; Cho, Jeong Gwan ; Park, Seung Jung. / Comparison of outcomes of patients with painless versus painful ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. In: American Journal of Cardiology. 2012 ; Vol. 109, No. 3. pp. 337-343.
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abstract = "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.",
author = "Cho, {Jae Yeong} and Jeong, {Myung Ho} and Ahn, {Young Keun} and Kim, {Jong Hyun} and Chae, {Shung Chull} and Kim, {Young Jo} and Hur, {Seung Ho} and Seong, {In Whan} and Hong, {Taek Jong} and Donghoon Choi and Cho, {Myeong Chan} and Kim, {Chong Jin} and Seung, {Ki Bae} and Chung, {Wook Sung} and Yangsoo Jang and Cho, {Seung Yun} and Rha, {Seung Woon} and Bae, {Jang Ho} and Cho, {Jeong Gwan} and Park, {Seung Jung}",
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Cho, JY, Jeong, MH, Ahn, YK, Kim, JH, Chae, SC, Kim, YJ, Hur, SH, Seong, IW, Hong, TJ, Choi, D, Cho, MC, Kim, CJ, Seung, KB, Chung, WS, Jang, Y, Cho, SY, Rha, SW, Bae, JH, Cho, JG & Park, SJ 2012, 'Comparison of outcomes of patients with painless versus painful ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention', American Journal of Cardiology, vol. 109, no. 3, pp. 337-343. https://doi.org/10.1016/j.amjcard.2011.09.017

Comparison of outcomes of patients with painless versus painful ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. / Cho, Jae Yeong; Jeong, Myung Ho; Ahn, Young Keun; Kim, Jong Hyun; Chae, Shung Chull; Kim, Young Jo; Hur, Seung Ho; Seong, In Whan; Hong, Taek Jong; Choi, Donghoon; Cho, Myeong Chan; Kim, Chong Jin; Seung, Ki Bae; Chung, Wook Sung; Jang, Yangsoo; Cho, Seung Yun; Rha, Seung Woon; Bae, Jang Ho; Cho, Jeong Gwan; Park, Seung Jung.

In: American Journal of Cardiology, Vol. 109, No. 3, 01.02.2012, p. 337-343.

Research output: Contribution to journalArticle

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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, Donghoon

AU - Cho, Myeong Chan

AU - Kim, Chong Jin

AU - Seung, Ki Bae

AU - Chung, Wook Sung

AU - Jang, Yangsoo

AU - Cho, Seung Yun

AU - Rha, Seung Woon

AU - Bae, Jang Ho

AU - Cho, Jeong Gwan

AU - Park, Seung Jung

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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