Patients admitted to the coronary care unit for chest pain: high risk subgroup for subsequent cardiovascular death

Area of Science:

• Cardiology
• Clinical Medicine
• Public Health

Background:

• Annually, ~300 patients admitted to Stanford Hospital's coronary care unit for ischemic chest pain and S-T changes do not have a confirmed myocardial infarction.
• These patients represent a significant group requiring further risk assessment and management strategies.

Purpose of the Study:

• To evaluate the long-term cardiovascular mortality and morbidity in patients initially diagnosed with suspected myocardial infarction but ultimately without infarction.
• To identify the risk profile of this patient subgroup after hospital discharge.

Main Methods:

• Retrospective study of 170 patients admitted to the coronary care unit with suspected myocardial infarction but no confirmed infarction.
• Follow-up data collection for a mean of 17.9 months to record cardiovascular mortality and nonfatal myocardial infarction events.

Main Results:

• Overall cardiovascular mortality rates were 4.2% at 1 month, 10.1% at 1 year, and 19.7% over the entire follow-up period.
• Of 23 deaths, 40% were sudden, and 13 were due to acute myocardial infarction or its complications.
• An additional 21 patients experienced nonfatal myocardial infarction during follow-up.

Conclusions:

• Patients with suspected myocardial infarction who are discharged without infarction remain at high risk for subsequent cardiovascular events and mortality.
• Further research is needed to identify specific clinical indicators for high-risk subgroups before hospital discharge to guide management.