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Korean J Intern Med. 2018 Nov;33(6):1111-1118. doi: 10.3904/kjim.2017.071. Epub 2017 Nov 10.

Prognostic significance of non-chest pain symptoms in patients with non-ST-segment elevation myocardial infarction.

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Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea.
Department of Cardiology, Chosun University Hospital, Gwangju, Korea.
Department of Cardiology, Chungbuk National University Hospital, Cheongju, Korea.
Department of Cardiology, Kyung Hee University Hospital, Seoul, Korea.
Department of Cardiology, Yeungnam University Medical Center, Daegu, Korea.



Chest pain is an essential symptom in the diagnosis of acute coronary syndrome (ACS). One-third of patients with ACS present atypically, which can influence their receiving timely lifesaving therapy.


A total of 617 NSTEMI patients from the Korea Acute MI Registry (KAMIR) and the Korea Working Group on MI (KorMI) databases were analyzed. The study population was divided into two groups by symptoms at presentation (typical symptoms group, 128; atypical symptoms groups, 128).


In this study population, 23% of patients presented without chest pain. After propensity score matching, the contact-to-device time (2,618 ± 381 minutes vs. 1,739 ± 241 minutes, p = 0.050), the symptoms-to-balloon time (3,426 ± 389 minutes vs. 2,366 ± 255 minutes, p = 0.024), and the door-to-balloon time (2,339 ± 380 minutes vs. 1,544 ± 244 minutes, p = 0.002) were significantly higher in the patients with atypical symptoms than in those with typical symptoms, respectively. Atypical symptoms were an independent predictor for 1-year mortality (hazard ratio, 2.820; 95% confidence interval, 1.058 to 7.515; p = 0.038). The Kaplan-Meier estimates showed higher risk for 12-month mortality in patients with atypical symptoms (p = 0.048) and no significant difference for 12-month major adverse cardiac events (p = 0.487).


Acute myocardial infarction patients with atypical symptoms were not rare in clinical practice and showed a high risk of delayed reperfusion therapy. After imbalance between the groups was minimized by use of propensity score matching, patients who presented atypically had a high mortality rate.


Chest pain; Non-ST elevated myocardial infarction; Propensity score

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