Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
J Intern Med. 2021 Aug;290(2):359-372. doi: 10.1111/joim.13272. Epub 2021 Mar 16.
Characteristics and prognosis of patients admitted with strong suspicion of myocardial infarction (MI) but discharged without an MI diagnosis are not well-described.
To compare background characteristics and cardiovascular outcomes in patients discharged with or without MI diagnosis.
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.
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.
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.
患有强烈疑似心肌梗死（MI）但未被诊断为 MI 而出院的患者的特征和预后尚未得到充分描述。
比较有或无 MI 诊断出院患者的背景特征和心血管结局。
DETO2X-AMI 试验（DETermination of the role of Oxygen in suspected Acute Myocardial Infarction，疑似急性心肌梗死中氧的作用的确定）比较了 6629 例强烈怀疑 MI 的患者，将其随机分为吸氧组或吸入空气组。本亚组分析的主要复合终点是全因死亡、因 MI、心力衰竭（HF）或中风再次住院的发生率，随访时间为 2.1 年（中位数；范围：1-3.7 年），不考虑随机治疗。
1619 例（24%）患者被诊断为非 MI，5010 例（76%）患者被诊断为 MI。两组患者在年龄上相似，但非 MI 患者更常见于女性，且合并症更多。在 30 天时，非 MI 患者的复合终点发生率为 2.8%（45 例/1619），而 MI 患者为 5.0%（250 例/5010），所有单个终点的发生率均较低。然而，在长期随访中，非 MI 患者的复合终点发生率增加到 17.7%（286 例/1619），而 MI 患者为 16.0%（804 例/5010），主要是由于全因死亡、中风和 HF 的发生率较高。
患有强烈疑似 MI 但出院时被诊断为其他疾病的患者在短期预后方面有更好的结果，但从一年开始，心血管结局和死亡率恶化，预后更差。
Zotero 插件