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European Heart Journal 2000 21(3):206-212; doi:10.1053/euhj.1999.1757
Copyright © 2000 by the European Society of Cardiology.
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Mortality of patients admitted with a suspected acute myocardial infarction in whom the diagnosis is not confirmed

C. Packhama,f1, D. Grayb, P. Silcocksc, N. Brownb, M. Melvilleb and J. Hamptonb

a University Division of Public Health Medicine and Epidemiology, Queens Medical Centre, Nottingham, U.K.
b University Division of Cardiovascular Medicine, Queens Medical Centre, Nottingham, U.K.
c Trent Institute of Health Services Research, Queens Medical Centre, Nottingham, U.K.

revised June 16, 1999; accepted June 7, 1999

Abstract

Aims To examine the survival of patients admitted with a suspected acute myocardial infarction in whom the diagnosis was not confirmed (‘possible myocardial infarction’).

Methods and Results A cohort study based on the Nottingham Heart Attack Register of 1716 sequential patients discharged alive from two acute teaching hospitals following admission in 1992. The main outcome was mortality following hospital discharge after 5 years of follow-up. Survival of the cohort of patients in whom myocardial infarction was suspected but not confirmed was 58% (95% C.I. 56 to 60%) after 5 years of follow-up, compared with an expected survival of 76% in an age/sex matched general population. Patients with ECG abnormalities that were not diagnostic of myocardial infarction had a 5-year survival of 56%, compared with 77% in those without such changes (P<0·00001). In the 703 patients who died in the first 5 years of follow-up, the cause of death was cardiovascular in at least 53% of cases. Survival following hospital discharge was worse than that in patients discharged alive in the same year following a confirmed myocardial infarction (63% vs 69% after 4 years of follow-upP =0·0016).

Conclusion Patients in this study had a substantially increased risk of death in the 5 years after discharge from hospital, compared with an age- and sex-matched population, and worse than patients discharged following a confirmed myocardial infarction. Almost half of those with ECG changes at the time of their admission died over the next 5 years. As over half of all deaths in this cohort were due to cardiovascular causes, further work is needed to identify patients at high and low risk of subsequent mortality who may warrant investigation and treatment following hospital discharge.

Key Words: Suspected myocardial infarction, survival

f1 Correspondence: Dr C. J. Packham, University Division of Public Health Medicine and Epidemiology, Queens Medical Centre, Nottingham, U.K.


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