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, Jung 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
Department of Internal Medicine, Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju 26426, Korea.
Center of Biomedical Data Science, Yonsei University Wonju College of Medicine, Wonju 26426, Korea.
J Clin Med. 2020 Feb 12;9(2):505. doi: 10.3390/jcm9020505.
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%, < 0.0001) and non-DM (20.4% vs. 6.3%, < 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.
非典型胸痛和糖尿病自主神经病变较少受到临床关注，导致诊断不足和治疗延误。为了评估非典型胸痛和糖尿病（DM）的长期临床影响，我们将2011年11月至2015年12月期间韩国急性心肌梗死（AMI）-国立卫生研究院的11159例患者分为四组（非典型糖尿病组、非典型非糖尿病组、典型糖尿病组和典型非糖尿病组）。主要终点定义为2年时以患者为导向的综合终点（POCE），包括全因死亡、任何心肌梗死（MI）和任何血运重建。在糖尿病组（29.5%对11.4%，<0.0001）和非糖尿病组（20.4%对6.3%，<0.0001）中，非典型胸痛患者的2年死亡率均高于典型胸痛患者。在调整模型中，非典型糖尿病组发生POCE（风险比（HR）1.76，95%置信区间（CI）1.48-2.10）、全因死亡（HR 2.23，95%CI 1.80-2.76）和任何MI（HR 2.34，95%CI 1.51-3.64）的风险最高。总之，非典型胸痛与AMI患者的死亡率显著相关。在四组中，非典型糖尿病组在2年时的临床结局最差。应用快速排除/纳入AMI方案将有助于改善临床结局。
