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Clinical Impact of Atypical Chest Pain and Diabetes Mellitus in Patients with Acute Myocardial Infarction from Prospective KAMIR-NIH Registry

Atypical chest pain and diabetic autonomic neuropathy attract less clinical attention, leading to underdiagnosis and delayed treatment. To evaluate the long-term clinical impact of atypical chest pain and diabetes mellitus (DM), we categorized 11,159 patients with acute myocardial infarction (AMI) f...

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Detalles Bibliográficos
Autores principales: Lee, Jun-Won, Moon, Jin Sil, Kang, Dae Ryong, Lee, Sang Jun, Son, Jung-Woo, Youn, Young Jin, Ahn, Sung Gyun, Ahn, Min-Soo, Kim, Jang-Young, Yoo, Byung-Su, Lee, Seung-Hwan, Kim, Ju Han, Jeong, Myung Ho, Park, Jong-Seon, Chae, Shung Chull, Hur, Seung Ho, Cho, Myeng-Chan, Rha, Seung Woon, Cha, Kwang Soo, Chae, Jei Keon, Choi, Dong-Ju, Seong, In Whan, Oh, Seok Kyu, Hwang, Jin Yong, Yoon, Junghan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074023/
https://www.ncbi.nlm.nih.gov/pubmed/32059609
http://dx.doi.org/10.3390/jcm9020505
Descripción
Sumario:Atypical chest pain and diabetic autonomic neuropathy attract less clinical attention, leading to underdiagnosis and delayed treatment. To evaluate the long-term clinical impact of atypical chest pain and diabetes mellitus (DM), we categorized 11,159 patients with acute myocardial infarction (AMI) from the Korea AMI-National Institutes of Health between November 2011 and December 2015 into four groups (atypical DM, atypical non-DM, typical DM, and typical non-DM). The primary endpoint was defined as patient-oriented composite endpoint (POCE) at 2 years including all-cause death, any myocardial infarction (MI), and any revascularization. Patients with atypical chest pain showed higher 2-year mortality than those with typical chest pain in both DM (29.5% vs. 11.4%, p < 0.0001) and non-DM (20.4% vs. 6.3%, p < 0.0001) groups. The atypical DM group had the highest risks of POCE (hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.48–2.10), all-cause death (HR 2.23, 95% CI 1.80–2.76) and any MI (HR 2.34, 95% CI 1.51–3.64) in the adjusted model. In conclusion, atypical chest pain was significantly associated with mortality in patients with AMI. Among four groups, the atypical DM group showed the worst clinical outcomes at 2 years. Application of rapid rule in/out AMI protocols would be beneficial to improve clinical outcomes.