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

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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.


  • B. Lindahl
  • L. Ljung
  • J. Herlitz
  • J. Alfredsson
  • D. Erlinge
  • T. Kellerth
  • E. Omerovic
  • A. Ravn-Fischer
  • D. Sparv
  • T. Yndigegn
  • P. Svensson
  • O. Östlund
  • T. Jernberg
  • S. K. James
  • R. Hofmann
  • DETO2X–SWEDEHEART Investigators
Enheter & grupper
Externa organisationer
  • Uppsala universitet
  • Uppsala University Hospital
  • Karolinska Institute
  • Högskolan i Borås
  • Linköping University
  • Örebro University
  • Sahlgrenska University Hospital
  • Göteborgs universitet
  • Södersjukhuset
  • Danderyd Hospital

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Kardiologi


TidskriftJournal of Internal Medicine
StatusE-pub ahead of print - 2021
Peer review utfördJa