Performance of reperfusion therapy and hospital mortality in ST-elevation myocardial infarction patients with non-chest pain complaints.
OBJECTIVE
ST-elevation myocardial infarction (STEMI) patients may visit the emergency department (ED) complaining of sensations of pain other than the chest. We investigated our performance of reperfusion therapy for STEMI patients presenting with non-chest pains.


METHODS
This was a retrospective observational cohort study. STEMI patients who underwent primary percutaneous coronary intervention (PCI) were divided into a chest pain group and a non-chest pain group. Clinical differences between the two groups and the influence of presenting with non-chest pains on door-to-electrocardiograms (ECG) time, door-to-balloon time, and hospital mortality were evaluated.


RESULTS
Of the 513 patients diagnosed with STEMI, 93 patients presented with non-chest pains. Patients in the non-chest pain group were older, more often female, and had a longer symptom onset to ED arrival time and higher Killip class than patients in the chest pain group. There was a statistically significant delay in door-to-ECG time (median, 2.0 min vs. 5.0 min; p<0.001) and door-to-balloon time (median, 57.5 min vs. 65.0 min; p<0.001) in patients without chest pain. In multivariate analysis, presenting with non-chest pains was an independent predictor for hospital mortality (odds ratio, 2.3; 95% confidence interval, 1.1-4.7). However, door-to-ECG time and door-to-balloon time were not factors related to hospital mortality.


CONCLUSIONS
STEMI patients presenting without chest pain showed higher baseline risk and hospital mortality than patients presenting with chest pain. ECG acquisition and primary PCI was delayed for patients presenting with non-chest pains, but not influencing hospital mortality. Efforts to reduce pre-hospital time delay for these patients are necessary.
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.
Jae Phil
JP
Na
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.
Kyu Chul
KC
Shin
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.
Seunghwan
S
Kim
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea. ; Department of Emergency Medicine, Kangwon National University, Chuncheon, Korea.
Yoo Seok
YS
Park
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.
Sung Phil
SP
Chung
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.
In Cheol
IC
Park
Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
Joon Min
JM
Park
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea. ; Department of Emergency Medicine, Kangwon National University, Chuncheon, Korea.
Min Joung
MJ
Kim
D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000175:diagnosis*; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies
Chest pain; electrocardiography; myocardial infarction; reperfusion