TY - JOUR
T1 - Association between pre-hospital chest pain severity and myocardial injury in ST elevation myocardial infarction
T2 - A post-hoc analysis of the AVOID study
AU - Fernando, Himawan
AU - Nehme, Ziad
AU - Peter, Karlheinz
AU - Bernard, Stephen
AU - Stephenson, Michael
AU - Bray, Janet E.
AU - Myles, Paul S.
AU - Stub, Romi
AU - Cameron, Peter
AU - Ellims, Andris H.
AU - Taylor, Andrew J.
AU - Kaye, David M.
AU - Smith, Karen
AU - Stub, Dion
AU - for the AVOID investigators
N1 - Funding Information:
ZN is funded by a National Health and Medical Research Council (NHMRC) Early Career Fellowship (#1146809). DS is funded by a National Heart Foundation Fellowship (#101908). The authors have no other conflicts of interest to declare.
Funding Information:
The AVOID study was funded by grants from Alfred Foundation, FALCK foundation and Paramedics Australia.
Publisher Copyright:
© 2021
PY - 2021/12
Y1 - 2021/12
N2 - Background: We sought to determine if an association exists between prehospital chest pain severity and markers of myocardial injury. Methods and Results: Patients with confirmed ST elevation myocardial infarction (STEMI) treated by emergency medical services were included in this retrospective cohort analysis of the AVOID study. The primary endpoint was the association of pre-hospital initial chest pain severity, cardiac biomarkers and infarct size based on cardiac magnetic resonance imaging. Groups were categorized based on moderate to severe chest pain (numerical rating scale pain ≥ 5/10) or less than moderate severity to compare procedural and clinical outcomes. 414 patients were included in the analysis. There was a weak correlation between initial pre-hospital chest pain severity and peak creatine kinase (r = 0.16, p = 0.001) and peak cardiac troponin I (r = 0.14, p = 0.005). Both were no longer significant after adjusting for known confounders. There was no association between moderate to severe chest pain on arrival and major adverse cardiac events at 6 months (20% vs. 14%, p=0.12). There was a weak correlation between history of ischemic heart disease (r = 0.16, p = 0.001), percutaneous coronary intervention (r = 0.16, p = 0.001), left anterior descending artery (r = 0.12, p = 0.012) as the culprit vessel and a weak negative correlation between age (r = -0.14, p = 0.039) and chest pain. Conclusion: Only a weak association between pre-hospital chest pain severity and markers of myocardial injury was identified, supporting more judicious use of opioid analgesia with a focus on patient comfort.
AB - Background: We sought to determine if an association exists between prehospital chest pain severity and markers of myocardial injury. Methods and Results: Patients with confirmed ST elevation myocardial infarction (STEMI) treated by emergency medical services were included in this retrospective cohort analysis of the AVOID study. The primary endpoint was the association of pre-hospital initial chest pain severity, cardiac biomarkers and infarct size based on cardiac magnetic resonance imaging. Groups were categorized based on moderate to severe chest pain (numerical rating scale pain ≥ 5/10) or less than moderate severity to compare procedural and clinical outcomes. 414 patients were included in the analysis. There was a weak correlation between initial pre-hospital chest pain severity and peak creatine kinase (r = 0.16, p = 0.001) and peak cardiac troponin I (r = 0.14, p = 0.005). Both were no longer significant after adjusting for known confounders. There was no association between moderate to severe chest pain on arrival and major adverse cardiac events at 6 months (20% vs. 14%, p=0.12). There was a weak correlation between history of ischemic heart disease (r = 0.16, p = 0.001), percutaneous coronary intervention (r = 0.16, p = 0.001), left anterior descending artery (r = 0.12, p = 0.012) as the culprit vessel and a weak negative correlation between age (r = -0.14, p = 0.039) and chest pain. Conclusion: Only a weak association between pre-hospital chest pain severity and markers of myocardial injury was identified, supporting more judicious use of opioid analgesia with a focus on patient comfort.
KW - Chest pain predictors
KW - Infarct size
KW - Myocardial infarction
KW - Opioid analgesia
KW - Pain severity
UR - http://www.scopus.com/inward/record.url?scp=85118823800&partnerID=8YFLogxK
U2 - 10.1016/j.ijcha.2021.100899
DO - 10.1016/j.ijcha.2021.100899
M3 - Article
C2 - 34815999
AN - SCOPUS:85118823800
SN - 2352-9067
VL - 37
JO - IJC Heart and Vasculature
JF - IJC Heart and Vasculature
M1 - 100899
ER -