{
  "abstract": "Background A significant proportion of patients with ST-elevation myocardial infarction (STEMI) present without cardiac symptoms of chest pain. Such presentations potentially affect the care they receive and ultimately affect these patients’ short and long-term outcomes. We analysed a national acute myocardial infarction (AMI) registry to characterise the demographics, processes of care and outcomes of non-chest pain (NCP) STEMI presentations.Methods Retrospective data for all STEMI cases from 2007 to 2020 were analysed from the Singapore Myocardial Infarction Registry. Cases which happened during inpatient and interfacility transfers were excluded. Univariable and multivariable logistic models were used to identify factors associated with NCP presentation. Cox proportional hazard models were constructed to investigate the prognostic influence of NCP on short-term and long-term mortality outcomes. ORs and HRs were calculated along with their 95% CI.Results Among 21 858 patients with first-onset STEMI, 12.6% presented with NCP. These patients were older, more likely to be women and Chinese and had never smoked. The prevalence of diabetes and hypertension was also higher. These patients were also less likely to present with other possible cardiac symptoms of AMI, such as dyspnoea and diaphoresis. They were less likely to receive percutaneous coronary intervention (36% vs 77%) and had longer door-to-balloon times (100 min vs 70 min). After adjusting for differences in baseline risk factors and clinical characteristics, NCP presentation was associated with a higher risk of all-cause mortality at 30 days (HR 2.93, 95% CI 2.62 to 3.28), 1 year (HR 2.80, 95% CI 2.56 to 3.06), 5 years (HR 2.47, 95% CI 2.30 to 2.66) and 10 years (HR 2.31, 95% CI 2.16 to 2.46).Conclusion After adjusting for baseline risk factors and treatments received, NCP presentation was still independently associated with worse survival outcomes. Further research is required to risk-stratify these patients and address the suboptimal treatment rates and outcomes.",
  "authors": [
    {
      "affiliations": [
        "Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore"
      ],
      "name": "Hon Jen Wong"
    },
    {
      "affiliations": [
        "Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore"
      ],
      "name": "Finn Jing Jie Teo"
    },
    {
      "affiliations": [
        "Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore"
      ],
      "name": "Chun En Yau"
    },
    {
      "affiliations": [
        "Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore"
      ],
      "name": "Chen Ee Low"
    },
    {
      "affiliations": [
        "Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore"
      ],
      "name": "Jordan Jun Yi Low"
    },
    {
      "affiliations": [
        "Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore"
      ],
      "name": "Tze Siang Koh"
    },
    {
      "affiliations": [
        "Department of Medicine, National University Hospital, Singapore"
      ],
      "name": "Yao Hao Teo"
    },
    {
      "affiliations": [
        "Department of Medicine, National University Hospital, Singapore"
      ],
      "name": "Yao Neng Teo"
    },
    {
      "affiliations": [
        "Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore",
        "Department of Cardiology, National University Heart Centre, Singapore"
      ],
      "name": "Ping Chai"
    },
    {
      "affiliations": [
        "Division of Cardiology, Department of Medicine, Ng Teng Fong General Hospital, Singapore"
      ],
      "name": "Poay Huan Loh"
    },
    {
      "affiliations": [
        "Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore",
        "Department of Cardiology, National University Heart Centre, Singapore"
      ],
      "name": "James W Yip"
    },
    {
      "affiliations": [
        "Emergency Medicine Academic Clinical Programme, SingHealth Duke-NUS, Singapore",
        "National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore",
        "Pre-Hospital and Emergency Care Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore"
      ],
      "name": "Andrew Fu Wah Ho"
    },
    {
      "affiliations": [
        "Department of Cardiology, Tan Tock Seng Hospital, Singapore"
      ],
      "name": "David Foo"
    },
    {
      "affiliations": [
        "Department of Cardiology, Tan Tock Seng Hospital, Singapore"
      ],
      "name": "Pow-Li Chia"
    },
    {
      "affiliations": [
        "Department of Cardiology, Khoo Teck Puat Hospital, Singapore"
      ],
      "name": "Patrick Zhan Yun Lim"
    },
    {
      "affiliations": [
        "Department of Cardiology, National Heart Centre Singapore, Singapore"
      ],
      "name": "Khung Keong Yeo"
    },
    {
      "affiliations": [
        "Department of Cardiology, Changi General Hospital, Singapore"
      ],
      "name": "Weien Chow"
    },
    {
      "affiliations": [
        "Department of Cardiology, Sengkang General Hospital, Singapore"
      ],
      "name": "Daniel Chong"
    },
    {
      "affiliations": [
        "The Hatter Cardiovascular Institute, University College London, London, UK",
        "Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore"
      ],
      "name": "Derek J Hausenloy"
    },
    {
      "affiliations": [
        "Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore",
        "Department of Cardiology, National University Heart Centre, Singapore"
      ],
      "name": "Mark Y Chan"
    },
    {
      "affiliations": [
        "Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore",
        "Department of Cardiology, National University Heart Centre, Singapore"
      ],
      "name": "Ching-Hui Sia"
    }
  ],
  "title": "Prognosis of patients with ST-elevation myocardial infarction presenting to the emergency department without chest pain: a retrospective nationwide cohort study",
  "uid": "6d94121b-79f8-5482-a321-8205968affc8"
}