Coronary disease & ACSCohort study
Prognosis of patients with ST-elevation myocardial infarction presenting to the emergency department without chest pain: a retrospective nationwide cohort study
- retrospective nationwide cohort study
Authors' conclusion
After adjusting for baseline risk factors and treatments received, NCP presentation was still independently associated with worse survival outcomes. Further research is required to risk-stratify these patients and address the suboptimal treatment rates and outcomes.
Study context
- Population
- Patients with first-onset ST-elevation myocardial infarction (STEMI) in the Singapore Myocardial Infarction Registry, 2007 to 2020, excluding cases during inpatient and interfacility transferspatients with first-onset STEMI, 12.6% presented with non-chest pain (NCP)
- Participants
- 21,858 patients
- Exposure
- NCP presentation vs chest pain presentation
Main finding
As reported in the abstract
Percutaneous coronary intervention
Observational data: associations, not effects.
Further findings
Door-to-balloon time
| Outcome | HR (95% CI) | |
|---|---|---|
| All-cause mortality · 30 days, 1 year, 5 years, 10 years · 30 days | 2.93 (2.62–3.28) | |
| All-cause mortality · 30 days, 1 year, 5 years, 10 years · 1 year | 2.80 (2.56–3.06) | |
| All-cause mortality · 30 days, 1 year, 5 years, 10 years · 5 years | 2.47 (2.30–2.66) | |
| All-cause mortality · 30 days, 1 year, 5 years, 10 years · 10 years | 2.31 (2.16–2.46) | |
| 0.20.5125Hazard ratio (log scale) |
- All-cause mortality: adjusted for differences in baseline risk factors and clinical characteristics
Characteristics of NCP patients
- Older, more likely to be women and Chinese and had never smoked
- Higher prevalence of diabetes and hypertension
- Less likely to present with other possible cardiac symptoms of acute myocardial infarction (AMI), such as dyspnoea and diaphoresis
Original publication
Prognosis of patients with ST-elevation myocardial infarction presenting to the emergency department without chest pain: a retrospective nationwide cohort study. Heart. Published 18 June 2026. doi:10.1136/heartjnl-2025-327601
Summarised from the published abstract; every number is checked against it