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Randomized Controlled Trial
. 2021 Aug;290(2):359-372.
doi: 10.1111/joim.13272. Epub 2021 Mar 16.

Poor long-term prognosis in patients admitted with strong suspicion of acute myocardial infarction but discharged with another diagnosis

B Lindahl  1   2 , L Ljung  3 , J Herlitz  4 , J Alfredsson  5 , D Erlinge  6 , T Kellerth  7 , E Omerovic  8   9 , A Ravn-Fischer  8   9 , D Sparv  6 , T Yndigegn  6 , P Svensson  3 , O Östlund  2 , T Jernberg  10 , S K James  1   2 , R Hofmann  3 ; DETO2X-SWEDEHEART Investigators
Affiliations
Free article
Randomized Controlled Trial

Poor long-term prognosis in patients admitted with strong suspicion of acute myocardial infarction but discharged with another diagnosis

B Lindahl et al. J Intern Med. 2021 Aug.
Free article

Abstract

Background: Characteristics and prognosis of patients admitted with strong suspicion of myocardial infarction (MI) but discharged without an MI diagnosis are not well-described.

Objectives: To compare background characteristics and cardiovascular outcomes in patients discharged with or without MI diagnosis.

Methods: 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.

Results: 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.

Conclusions: 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.

Trial registration: ClinicalTrials.gov NCT01787110.

Keywords: acute myocardial infarction; cardiovascular clinical research; cardiovascular risk factors; chest pain; noncardiac chest pain; randomized clinical trial.

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References

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