Comparison of Outcomes of Patients With Painless Versus Painful ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Jae Yeong ChoMyung Ho JeongYoung Keun AhnJong Hyun KimShung Chull ChaeYoung Jo KimSeung Ho HurIn Whan SeongTaek Jong HongDong Hoon ChoiMyeong Chan ChoChong Jin KimKi Bae SeungWook Sung ChungYang Soo JangSeung Yun ChoSeung Woon RhaJang Ho BaeJeong Gwan ChoSeung Jung Park
Dept. of Internal Medicine (내과학)
Issue Date
American Journal of Cardiology, Vol.109(3) : 337-343, 2012
There are few data available on the prognosis of painless ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine the incidence, clinical characteristics, and outcomes of painless STEMI. We analyzed the Korea Acute Myocardial Infarction Registry (KAMIR) study, which enrolled 7,288 patients with STEMI (61.8 12.8 years old, 74% men; painless STEMI group, n 763; painful STEMI group, n 6,525). End points were in-hospital mortality and 1-year major adverse cardiac events (MACEs). Patients with painless STEMI were older and more likely to be women, nonsmokers, diabetic, and normolipidemic and to have a higher Killip class. The painless group had more in-hospital deaths (5.9% vs 3.6%, p 0.026) and 1-year MACEs (26% vs 19%, p 0.002). In Cox proportional hazards analysis, hypotension (hazard ratio [HR] 4.40, 95% confidence interval [CI] 1.41 to 13.78, p 0.011), low left ventricular ejection fraction (HR 3.12, 95% CI 1.21 to 8.07, p 0.019), and a high Killip class (HR 3.48, 95% CI 1.19 to 10.22, p 0.023) were independent predictors of 1-year MACEs in patients with painless STEMI. In conclusion, painless STEMI was associated with more adverse outcomes than painful STEMI and late detection may have contributed significantly to total ischemic burden. These results warrant more investigations for methodologic development in the diagnosis of silent ischemia and painless STEMI. © 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;109:337–343)
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