DeBarmore Bailey M, Zègre-Hemsey Jessica K, Kucharska-Newton Anna M, Michos Erin D, Rosamond Wayne D
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Am Heart J Plus. 2023 Jan;25. doi: 10.1016/j.ahjo.2022.100239. Epub 2022 Dec 8.
Our objective was to describe characteristics of patients presenting with and without ischemic pain among those diagnosed with acute myocardial infarction (MI) using individual-level data from the Atherosclerosis Risk in Communities Study from 2005 to 2019.
Acute MI included events deemed definite or probable MI by a physician panel based on ischemic pain, cardiac biomarkers, and ECG evidence. Patient characteristics included age at hospitalization, sex, race/ethnicity, comorbidities (smoking status, diabetes, hypertension, history of previous stroke, MI, or cardiovascular procedure, and history of valvular disease or cardiomyopathy) and in-hospital complications occurring during the event of interest (pulmonary edema, pulmonary embolism, in-hospital stroke, pneumonia, cardiogenic shock, ventricular fibrillation). Analyses were stratified by MI subtype (STEMI, NSTEMI, Unclassified) and patient characteristics and 28-day case fatality was compared between MI presenting with or without ischemic pain.
Between 2005 and 2019, there were 1711 hospitalized definite/probable MI events (47 % female, 26 % black, and age of 78 [6.7 years]). A smaller proportion of STEMI patients presented without ischemic pain compared to NSTEMI patients (20 % vs 32 %). Race, sex, age, and comorbidity profiles did not differ significantly across ischemic pain presentations. Patients presenting without ischemic pain had a higher 28-day all-cause case fatality after adjusting for age, race, sex, and comorbidities. However, after further adjustment, time from symptom onset to hospital arrival, time to treatment, and in-hospital complications explained the difference in 28-day case fatality between ischemic pain presentations.
Future research should focus on differences in treatment delay across ischemic pain presentations rather than sex differences in acute coronary syndrome presentation.
我们的目标是利用2005年至2019年社区动脉粥样硬化风险研究的个体水平数据，描述急性心肌梗死（MI）诊断患者中有无缺血性疼痛的特征。
急性心肌梗死包括医生小组根据缺血性疼痛、心脏生物标志物和心电图证据判定为明确或可能的心肌梗死事件。患者特征包括住院年龄、性别、种族/民族、合并症（吸烟状况、糖尿病、高血压、既往中风、心肌梗死或心血管手术史，以及瓣膜病或心肌病病史）和感兴趣事件期间发生的院内并发症（肺水肿、肺栓塞、院内中风、肺炎、心源性休克、心室颤动）。分析按心肌梗死亚型（ST段抬高型心肌梗死、非ST段抬高型心肌梗死、未分类）和患者特征进行分层，并比较有无缺血性疼痛的心肌梗死患者的28天病死率。
2005年至2019年期间，有1711例住院的明确/可能心肌梗死事件（47%为女性，26%为黑人，年龄为78岁[6.7岁]）。与非ST段抬高型心肌梗死患者相比，ST段抬高型心肌梗死患者无缺血性疼痛的比例较小（20%对32%）。种族、性别、年龄和合并症情况在有无缺血性疼痛表现之间没有显著差异。在调整年龄、种族、性别和合并症后，无缺血性疼痛的患者28天全因病死率较高。然而，在进一步调整后，从症状发作到入院的时间、治疗时间和院内并发症解释了缺血性疼痛表现之间28天病死率的差异。
未来的研究应关注缺血性疼痛表现之间治疗延迟的差异，而不是急性冠状动脉综合征表现中的性别差异。
