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

Title
Comparison of Outcomes of Patients With Painless Versus Painful ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention
Author(s)
김영조조재영[조재영]정명호[정명호]안영근[안영근]김종현[김종현]채성철[채성철]허성호[허성호]성인환[성인환]홍택종[홍택종]최동훈[최동훈]조명찬[조명찬]김종진[김종진]승기배[승기배]정욱성[정욱성]장양수[장양수]조승윤[조승윤]하승운[하승운]배장호[배장호]박승정[박승정]
Keywords
ARTERY-DISEASE; ADENOSINE RECEPTORS; ASYMPTOMATIC MEN; ISCHEMIA; SILENT; DYSFUNCTION; PREVALENCE; PROGNOSIS
Issue Date
201202
Publisher
EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
Citation
AMERICAN JOURNAL OF CARDIOLOGY, v.109, no.3, pp.337 - 343
Abstract
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. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;109:337-343)
URI
http://hdl.handle.net/YU.REPOSITORY/29878http://dx.doi.org/10.1016/j.amjcard.2011.09.017
ISSN
0002-9149
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의과대학 > 내과학교실 > Articles
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