Predictors and mode of death over 5 years amongst patients admitted to the emergency department with acute chest pain or other symptoms raising suspicion of acute myocardial infarction

Abstract

Herlitz J, Karlson BW, Lindqvist J, Sjölin M (Sahlgrenska University Hospital, Göteborg, Sweden). Predictors and mode of death over 5 years amongst patients admitted to the emergency department with acute chest pain or other symptoms raising suspicion of acute myocardial infarction. J Intern Med 1998; 243 : 41–48. Aim To describe the mortality and mode of death over 5 years, and factors associated with death amongst patients with acute chest pain. Patients All patients who came to the emergency department at Sahlgrenska Hospital in Göteborg with acute chest pain or other symptoms raising suspicion of acute myocardial infarction (AMI) during a 21‐month period. Results In all, 5241 patients were evaluated, of whom 1345 (26%) died during the 5 years of follow‐up. The following factors were independent predictors of an increased risk of death: age ( P < 0.001); male sex ( P < 0.001); symptoms of acute congestive heart failure ( P < 0.001) or unspecific symptoms on admission ( P < 0.05); smoking ( P < 0.001); a history of either congestive heart failure ( P < 0.001), diabetes mellitus ( P < 0.001), previous myocardial infarction ( P < 0.001) or hypertension ( P < 0.05); initial degree of suspicion of AMI ( P < 0.001) and presence of pathological electrocardiogram ( P < 0.001) on admission to hospital. Amongst patients who died, 66% died a cardiac death and 35% died in association with a myocardial infarction. Conclusion Amongst patients admitted to the emergency department due to chest pain or other symptoms raising suspicion of AMI, several predictors based on clinical history and clinical presentation can be defined, which are strongly related to the long‐term prognosis.