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.
Published Version
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