Clinical impact of atypical chest pain and diabetes mellitus in patients with acute myocardial infarction from prospective KAMIR-NIH registry

Jun Won Lee, Jin Sil Moon, Dae Ryong Kang, Sang Jun Lee, Jung Woo Son, Young Jin Youn, Sung Gyun Ahn, Min Soo Ahn, Jang Young Kim, Byung Su Yoo, Seung Hwan Lee, Ju Han Kim, Myung Ho Jung, Jong Seon Park, Shung Chull Chae, Seung Ho Hur, Myeng Chan Cho, Seung Woon Rha, Kwang Soo Cha, Jei Keon ChaeDong Ju Choi, In Whan Seong, Seok Kyu Oh, Jin Yong Hwang, Junghan Yoon

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

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.

Original languageEnglish
Article number505
JournalJournal of Clinical Medicine
Volume9
Issue number2
DOIs
Publication statusPublished - 2020 Feb

Keywords

  • Chest pain
  • Diabetes
  • Myocardial infarction

ASJC Scopus subject areas

  • Medicine(all)

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