Poor long-term prognosis in patients admitted with strong suspicion of acute myocardial infarction but discharged with another diagnosis
(2021) In Journal of Internal Medicine 290(2). p.359-372- Abstract
Background: Characteristics and prognosis of patients admitted with strong suspicion of myocardial infarction (MI) but discharged without an MI diagnosis are not well-described. Objectives: To compare background characteristics and cardiovascular outcomes in patients discharged with or without MI diagnosis. Methods: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial compared 6629 patients with strong suspicion of MI randomized to oxygen or ambient air. The main composite end-point of this subgroup analysis was the incidence of all-cause death, rehospitalization with MI, heart failure (HF) or stroke during a follow-up of 2.1 years (median; range: 1–3.7 years) irrespective of randomized... (More)
Background: Characteristics and prognosis of patients admitted with strong suspicion of myocardial infarction (MI) but discharged without an MI diagnosis are not well-described. Objectives: To compare background characteristics and cardiovascular outcomes in patients discharged with or without MI diagnosis. Methods: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial compared 6629 patients with strong suspicion of MI randomized to oxygen or ambient air. The main composite end-point of this subgroup analysis was the incidence of all-cause death, rehospitalization with MI, heart failure (HF) or stroke during a follow-up of 2.1 years (median; range: 1–3.7 years) irrespective of randomized treatment. Results: 1619 (24%) received a non-MI discharge diagnosis, and 5010 patients (76%) were diagnosed with MI. Groups were similar in age, but non-MI patients were more commonly female and had more comorbidities. At thirty days, the incidence of the composite end-point was 2.8% (45 of 1619) in non-MI patients, compared to 5.0% (250 of 5010) in MI patients with lower incidences in all individual end-points. However, for the long-term follow-up, the incidence of the composite end-point increased in the non-MI patients to 17.7% (286 of 1619) as compared to 16.0% (804 of 5010) in MI patients, mainly driven by a higher incidence of all-cause death, stroke and HF. Conclusions: Patients admitted with a strong suspicion of MI but discharged with another diagnosis had more favourable outcomes in the short-term perspective, but from one year onwards, cardiovascular outcomes and death deteriorated to a worse long-term prognosis.
(Less)
- author
- author collaboration
- organization
- publishing date
- 2021
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- acute myocardial infarction, cardiovascular clinical research, cardiovascular risk factors, chest pain, noncardiac chest pain, randomized clinical trial
- in
- Journal of Internal Medicine
- volume
- 290
- issue
- 2
- pages
- 359 - 372
- publisher
- Wiley-Blackwell
- external identifiers
-
- pmid:33576075
- scopus:85102508461
- ISSN
- 0954-6820
- DOI
- 10.1111/joim.13272
- language
- English
- LU publication?
- yes
- id
- 1f785c19-03bc-48c8-a21b-0169748dd122
- date added to LUP
- 2021-03-29 14:50:24
- date last changed
- 2024-08-24 15:44:54
@article{1f785c19-03bc-48c8-a21b-0169748dd122, abstract = {{<p>Background: Characteristics and prognosis of patients admitted with strong suspicion of myocardial infarction (MI) but discharged without an MI diagnosis are not well-described. Objectives: To compare background characteristics and cardiovascular outcomes in patients discharged with or without MI diagnosis. Methods: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial compared 6629 patients with strong suspicion of MI randomized to oxygen or ambient air. The main composite end-point of this subgroup analysis was the incidence of all-cause death, rehospitalization with MI, heart failure (HF) or stroke during a follow-up of 2.1 years (median; range: 1–3.7 years) irrespective of randomized treatment. Results: 1619 (24%) received a non-MI discharge diagnosis, and 5010 patients (76%) were diagnosed with MI. Groups were similar in age, but non-MI patients were more commonly female and had more comorbidities. At thirty days, the incidence of the composite end-point was 2.8% (45 of 1619) in non-MI patients, compared to 5.0% (250 of 5010) in MI patients with lower incidences in all individual end-points. However, for the long-term follow-up, the incidence of the composite end-point increased in the non-MI patients to 17.7% (286 of 1619) as compared to 16.0% (804 of 5010) in MI patients, mainly driven by a higher incidence of all-cause death, stroke and HF. Conclusions: Patients admitted with a strong suspicion of MI but discharged with another diagnosis had more favourable outcomes in the short-term perspective, but from one year onwards, cardiovascular outcomes and death deteriorated to a worse long-term prognosis.</p>}}, author = {{Lindahl, B. and Ljung, L. and Herlitz, J. and Alfredsson, J. and Erlinge, D. and Kellerth, T. and Omerovic, E. and Ravn-Fischer, A. and Sparv, D. and Yndigegn, T. and Svensson, P. and Östlund, O. and Jernberg, T. and James, S. K. and Hofmann, R.}}, issn = {{0954-6820}}, keywords = {{acute myocardial infarction; cardiovascular clinical research; cardiovascular risk factors; chest pain; noncardiac chest pain; randomized clinical trial}}, language = {{eng}}, number = {{2}}, pages = {{359--372}}, publisher = {{Wiley-Blackwell}}, series = {{Journal of Internal Medicine}}, title = {{Poor long-term prognosis in patients admitted with strong suspicion of acute myocardial infarction but discharged with another diagnosis}}, url = {{http://dx.doi.org/10.1111/joim.13272}}, doi = {{10.1111/joim.13272}}, volume = {{290}}, year = {{2021}}, }