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

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@article{1f785c1903bc48c8a21b0169748dd122,
title = "Poor long-term prognosis in patients admitted with strong suspicion of acute myocardial infarction but discharged with another diagnosis",
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.",
keywords = "acute myocardial infarction, cardiovascular clinical research, cardiovascular risk factors, chest pain, noncardiac chest pain, randomized clinical trial",
author = "B. Lindahl and L. Ljung and J. Herlitz and J. Alfredsson and D. Erlinge and T. Kellerth and E. Omerovic and A. Ravn-Fischer and D. Sparv and T. Yndigegn and P. Svensson and O. {\"O}stlund and T. Jernberg and James, {S. K.} and R. Hofmann and {DETO2X-SWEDEHEART Investigators}",
year = "2021",
doi = "10.1111/joim.13272",
language = "English",
journal = "Journal of Internal Medicine",
issn = "1365-2796",
publisher = "Wiley-Blackwell",

}