Comparison of Outcomes of Patients With Painless Versus Painful ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

作者：Cho Jae Yeong; Jeong Myung Ho^*; Ahn Young Keun; Kim Jong Hyun; Chae Shung Chu; Kim Young Jo; Hur Seung Ho; Seong In Whan; Hong Taek Jong; Choi Dong Hoon; Cho Myeong Chan; Kim Chong Jin; Seung Ki Bae; Chung Wook Sung; Jang Yang Soo; Cho Seung Yun; Rha Seung Woon; Bae Jong Ho; Cho Jeong Gwan; Park Seung Jung

来源：American Journal of Cardiology, 2012, 109(3): 337-343.

DOI：10.1016/j.amjcard.2011.09.017

There are few data available on the prognosis of painless ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine the incidence, clinical characteristics, and outcomes of painless STEMI. We analyzed the Korea Acute Myocardial Infarction Registry (KAMIR) study, which enrolled 7,288 patients with STEMI (61.8 +/- 12.8 years old, 74% men; painless STEMI group, n = 763; painful STEMI group, n = 6,525). End points were in-hospital mortality and 1-year major adverse cardiac events (MACEs). Patients with painless STEMI were older and more likely to be women, nonsmokers, diabetic, and normolipidemic and to have a higher Killip class. The painless group had more in-hospital deaths (5.9% vs 3.6%, p = 0.026) and 1-year MACEs (26% vs 19%, p = 0.002). In Cox proportional hazards analysis, hypotension (hazard ratio [HR] 4.40, 95% confidence interval [CI] 1.41 to 13.78, p = 0.011), low left ventricular ejection fraction (HR 3.12, 95% CI 1.21 to 8.07, p = 0.019), and a high Killip class (HR 3.48, 95% CI 1.19 to 10.22, p = 0.023) were independent predictors of 1-year MACEs in patients with painless STEMI. In conclusion, painless STEMI was associated with more adverse outcomes than painful STEMI and late detection may have contributed significantly to total ischemic burden. These results warrant more investigations for methodologic development in the diagnosis of silent ischemia and painless STEMI.

• 出版日期2012-2-1