Prognosis after hospitalization for @entity583 not accompanied by typical @entity63 XXXX . The Multicenter Diltiazem Postinfarction Trial Research Group.

@entity662 @entity1 @entity712 @entity6 @entity63 @entity1353 @entity16 @entity951 @entity158 @entity583 @entity204 @entity1002
PURPOSE: Although @entity63 -type @entity662 generally identifies @entity583 ( @entity583 ), some @entity1 are hospitalized for @entity583 without this symptom. Long-term mortality and morbidity after @entity583 presenting with alternative warning symptoms have not been examined previously. We therefore assessed the prognostic implications of the absence of typical @entity662 as well as other recognized risk predictors in @entity1 hospitalized with @entity583 . @entity1 AND METHODS: Data were obtained during the Multicenter Diltiazem Postinfarction Trial. @entity158 status and other baseline characteristics were determined prospectively by study coordinators according to simple, prespecified criteria. @entity1 were then examined every 3 to 4 months until trial completion. We applied chi-square methods, life-table analysis, and multivariate analysis to assess the strength and independence of prognostic power associated with each baseline variable. RESULTS: Of 2,464 @entity1 enrolled 3 to 15 days after enzyme-documented @entity583 , 115 @entity1 lacked typical @entity63 -type chest in on presentation (the "nonpainful" group). After 25 months' mean follow-up, cardiac mortality was 20% for nonpainful @entity1 and 10% for 2,349 @entity1 with typical @entity158 (the "painful" group), P < 0.001. Similar increments were seen in total @entity204 (27% nonpainful versus 13% painful, P < 0.001) and cardiac events, namely, @entity204 or nonfatal reinfarction (24% nonpainful versus 17% painful, P = 0.001). Late @entity712 was more frequent (17% nonpainful versus 7% painful, P < 0.001), but unstable @entity951 was less (6% nonpainful versus 16% painful, P = 0.005). At outset, nonpainful @entity1 had more @entity1002 and @entity6 . However, nonpainful @entity583 predicted worse outcome even when these problems were absent. Logistic regression confirmed greater @entity204 risk in the nonpainful group (hazard ratio = 2.05) and showed that predictive power of nonpainful status was independent of baseline ejection fraction, Holter data, concomitant @entity6 , and other covariates. CONCLUSIONS: @entity1 hospitalized with nonpainful @entity583 are much more likely to experience late @entity204 or @entity712 than are @entity1 with painful @entity583 . In part, this probably reflects more @entity16 with alternative warning symptoms such as @entity1353 . However, our data suggest that defective perception of warning @entity158 also provides a long-term risk to life that is independent of previously known predictors of poor outcome.
