Association between pre-hospital chest pain severity and myocardial injury in ST elevation myocardial infarction: A post-hoc analysis of the AVOID study

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 coho...

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Autores principales:	Himawan Fernando, Ziad Nehme, Karlheinz Peter, Stephen Bernard, Michael Stephenson, Janet E. Bray, Paul S. Myles, Romi Stub, Peter Cameron, Andris H. Ellims, Andrew J. Taylor, David M. Kaye, Karen Smith, Dion Stub
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Myocardial infarction Chest pain predictors Infarct size Pain severity Opioid analgesia Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/5abf34d285b34fa48031f76f9b10ab5e
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spelling	oai:doaj.org-article:5abf34d285b34fa48031f76f9b10ab5e2021-11-10T04:29:14ZAssociation between pre-hospital chest pain severity and myocardial injury in ST elevation myocardial infarction: A post-hoc analysis of the AVOID study2352-906710.1016/j.ijcha.2021.100899https://doaj.org/article/5abf34d285b34fa48031f76f9b10ab5e2021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2352906721001871https://doaj.org/toc/2352-9067Background: 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.Himawan FernandoZiad NehmeKarlheinz PeterStephen BernardMichael StephensonJanet E. BrayPaul S. MylesRomi StubPeter CameronAndris H. EllimsAndrew J. TaylorDavid M. KayeKaren SmithDion StubElsevierarticleMyocardial infarctionChest pain predictorsInfarct sizePain severityOpioid analgesiaDiseases of the circulatory (Cardiovascular) systemRC666-701ENInternational Journal of Cardiology: Heart & Vasculature, Vol 37, Iss , Pp 100899- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Myocardial infarction Chest pain predictors Infarct size Pain severity Opioid analgesia Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Myocardial infarction Chest pain predictors Infarct size Pain severity Opioid analgesia Diseases of the circulatory (Cardiovascular) system RC666-701 Himawan Fernando Ziad Nehme Karlheinz Peter Stephen Bernard Michael Stephenson Janet E. Bray Paul S. Myles Romi Stub Peter Cameron Andris H. Ellims Andrew J. Taylor David M. Kaye Karen Smith Dion Stub Association between pre-hospital chest pain severity and myocardial injury in ST elevation myocardial infarction: A post-hoc analysis of the AVOID study
description	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.
format	article
author	Himawan Fernando Ziad Nehme Karlheinz Peter Stephen Bernard Michael Stephenson Janet E. Bray Paul S. Myles Romi Stub Peter Cameron Andris H. Ellims Andrew J. Taylor David M. Kaye Karen Smith Dion Stub
author_facet	Himawan Fernando Ziad Nehme Karlheinz Peter Stephen Bernard Michael Stephenson Janet E. Bray Paul S. Myles Romi Stub Peter Cameron Andris H. Ellims Andrew J. Taylor David M. Kaye Karen Smith Dion Stub
author_sort	Himawan Fernando
title	Association between pre-hospital chest pain severity and myocardial injury in ST elevation myocardial infarction: A post-hoc analysis of the AVOID study
title_short	Association between pre-hospital chest pain severity and myocardial injury in ST elevation myocardial infarction: A post-hoc analysis of the AVOID study
title_full	Association between pre-hospital chest pain severity and myocardial injury in ST elevation myocardial infarction: A post-hoc analysis of the AVOID study
title_fullStr	Association between pre-hospital chest pain severity and myocardial injury in ST elevation myocardial infarction: A post-hoc analysis of the AVOID study
title_full_unstemmed	Association between pre-hospital chest pain severity and myocardial injury in ST elevation myocardial infarction: A post-hoc analysis of the AVOID study
title_sort	association between pre-hospital chest pain severity and myocardial injury in st elevation myocardial infarction: a post-hoc analysis of the avoid study
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/5abf34d285b34fa48031f76f9b10ab5e
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Association between pre-hospital chest pain severity and myocardial injury in ST elevation myocardial infarction: A post-hoc analysis of the AVOID study

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