Abstract 308: Incidence of Non-Cardiac Chest Pain in Follow-up After Acute Myocardial Infarction and Association with Clinical Outcomes

Abstract

Background: Non-cardiac chest pain is common in the general population, but its incidence after acute myocardial infarction (AMI) is unknown. Moreover, whether patients with non-cardiac chest pain after AMI experience poorer outcomes than patients without these symptoms is unclear. Methods: Within the 24-US center TRIUMPH registry, we classified patients as having or not having a physician-adjudicated readmission with non-cardiac chest pain and assessed patients' health status and 2-year mortality. Patients' health status was evaluated using the quality of life domain of the disease-specific Seattle Angina Questionnaire (SAQ QoL) and the physical and mental component summary scores of the generic Short Form 12 (SF-12) at 1, 6, and 12 months after AMI. The associations between non-cardiac chest pain hospitalization and 2-year mortality and patients' health status were assessed using hierarchical, multivariable logistic regression and repeated measures linear regression, respectively, adjusting for potential confounders. Results: Of 3127 AMI patients, 130 (4.2%) were hospitalized with non-cardiac chest pain over the follow-up period. Two-year mortality was similar between patients with (3.8%) and without non-cardiac chest pain (6.8%, p=0.19). In contrast, patients hospitalized with non-cardiac chest pain had worse adjusted disease-specific health status (SAQ-QoL: -10.61 points [95% CI -13.48, -7.74])) and generic health status (SF-12 physical component summary: -2.78 points [95% CI -4.24, -1.32]); SF-12 mental component summary (-3.51 points [95% CI -4.88, -2.14]). Married patients were independently less likely to be hospitalized (OR 0.6, 95% CI 0.4-0.9) while those with a history of chronic heart failure were more likely to be admitted with non-cardiac chest pain (OR 2.2, 95% CI 1.2-3.9). Conclusions: Patients hospitalized with non-cardiac chest pain experienced worse health status in the first year after AMI than patients without these symptoms, suggesting these patients experience ongoing, rather than transient, poor health status post-AMI. Further research is needed to elucidate the etiology of poor health status in these patients and develop novel treatment strategies for improving their physical functioning and quality of life.