Patient characteristics and outcomes of acute myocardial infarction presenting without ischemic pain: Insights from the Atherosclerosis Risk in Communities Study

Fig. 1. Defining ischemic pain. The presence of pain is first determined by reviewing the medical record for acute episodes of pain or discomfort within 72 h of hospital arrival (out-of-hospital events) or in conjunction with in-hospital events. Pain is then classified as cardiac (ischemic) origin or non-ischemic origin by reviewing the full medical record. MI: myocardial infarction.

Fig. 2. Comorbidities among definite/probable MI events presenting with and without ischemic pain, ARIC cohort surveillance 2005–2019. Predicted probabilities and 95 % confidence intervals were estimated from margins after logistic regression adjusted for age at event and year of event and presented for STEMI and NSTEMI. MI: Myocardial infarction. STEMI: ST-segment elevated MI. NSTEMI: non-ST-segment elevated MI.

Fig. 3. Time from symptom onset to hospital arrival and treatment among definite/probable hospitalized MI events presenting with and without ischemic pain, ARIC cohort surveillance 2005–2019. Predicted probabilities and 95 % confidence intervals were estimated from margins after logistic regression adjusted for age at event and year of event and presented for STEMI and NSTEMI. Treatment included stent placement, intracoronary or intravenous reperfusion, coronary artery bypass graft, percutaneous coronary intervention/angioplasty, and atherectomy. MI: Myocardial infarction. STEMI: ST-segment elevated MI. NSTEMI: non-ST-segment elevated MI.

Fig. 4. Adjusted 28-day case fatality among definite/probable MI events presenting with and without ischemic pain, ARIC cohort surveillance 2005–2019. Adjusted 28-day case fatality (predicted probabilities of dying from any cause within 28 days of MI event) and 95 % confidence intervals were estimated from margins after logistic regression and presented for STEMI and NSTEMI. Models were progressively adjusted from age and event year (Model 1) to include sex and race (Model 2), comorbidities and smoking status (Model 3A), time from symptom onset to arrival, time from symptom onset to treatment, and in-hospital complications (Model 3B) and all variables (Model 4). In-hospital complications included acute heart failure, pulmonary edema, pulmonary embolism, in-hospital stroke, pneumonia, cardiogenic shock, and ventricular fibrillation. MI: Myocardial infarction. STEMI: ST-segment elevated MI. NSTEMI: non-ST-segment elevated MI.