title: Impact of non-chest pain complaint as a presenting symptom on door-to-balloon time and clinical outcomes in patients with acute ST-elevation myocardial infarction.
abstract: Many patients with ST-elevation myocardial infarctions (STEMIs) have non-chest pain complaints and are given low priority during triage. This prospective, multicenter, observational, registry-based study investigated the impact of non-chest pain complaints on door-to-balloon (DTB) time and clinical outcomes. Patients with STEMI who had undergone primary percutaneous coronary intervention were compared with respect to the presence of chest pain or non-chest pain complaints as presenting symptoms. To eliminate biased estimates, a propensity score model was built, and 2 cohorts of 1:1 matched patients were obtained. Propensity matching identified 2 cohorts of 976 patients each. After comparing patients with chest pain and those with non-chest pain complaints, significant delays in the median DTB time were noted (74 vs 84 minutes, respectively; p <0.001). Non-chest pain complaints were independent predictors of DTB time in the multivariate linear regression models. In-hospital mortality (adjusted hazard ratio [HR] 1.402, 95% confidence interval [CI] 0.727 to 2.705, p = 0.313), all-cause mortality (adjusted HR 1.175, 95% CI 0.453 to 3.853, p = 0.642), and major adverse cardiac events at follow-up (adjusted HR 0.139, 95% CI 0.876 to 1.48, p = 0.331) did not differ between the 2 groups of patients. In conclusion, short- and long-term clinical outcomes in patients with STEMI with non-chest pain complaints do not differ from those of patients with chest pain as the presenting symptom, despite having delayed diagnosis and reperfusion.
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Jin Sup
authors.initials: JS
authors.lastname: Park
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea; Medical Research Institute, Pusan National University Hospital, Busan, South Korea. Electronic address: cks@pusan.ac.kr.
authors.forename: Kwang Soo
authors.initials: KS
authors.lastname: Cha
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Donghun
authors.initials: D
authors.lastname: Shin
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Dae Sung
authors.initials: DS
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Hye Won
authors.initials: HW
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Jun-Hyok
authors.initials: JH
authors.lastname: Oh
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Jung Hyun
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Han Cheol
authors.initials: HC
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Taek Jong
authors.initials: TJ
authors.lastname: Hong
authors.affiliation: Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.affiliation: Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.affiliation: Department of Cardiology, Kyungpook National University Hospital, Daegu, South Korea.
authors.forename: Shung Chull
authors.initials: SC
authors.lastname: Chae
authors.affiliation: Department of Cardiology, Yeungnam University Hospital, Daegu, South Korea.
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D004562:Electrocardiography; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D057216:Propensity Score; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014218:Triage