Mortality of patients admitted with a suspected acute myocardial infarction in whom the diagnosis is not confirmed

Aims To examine the survival of patients admitted with a suspected acute my ocardial infarction in whom confirmed ('possible myocardial infarction'). Methods and Results A cohort study based on the Nottingham Heart Attack Reg ister of 1716 sequential patients discharged alive from two acute teaching hospitals following admission in 1992. The main outcome was mortality follo wing hospital discharge after 5 years of followup. Survival of the cohort o f patients in whom myocardial infarction was suspected but not confirmed wa s 58% (95% C.I. 56 to 60%) after 5 years of follow-up, compared with an exp ected survival of 76% in an age/sex matched general population. Patients wi th ECG abnormalities that were not diagnostic of myocardial infarction had a 5-year survival of 56%, compared with 77% in those without such changes ( P < 0.00001). In the 703 patients who died in the first 5 years of follow-u p, the cause of death was cardiovascular in at least 53% of cases. Survival following hospital discharge was worse than that in patients discharged al ive in the same year following a confirmed myocardial infarction (63% vs 69 % after 4 years of follow-up P = 0.0016). Conclusion Patients in this study had a substantially increased risk of dea th in the 5 years after discharge from hospital, compared with an age- and sex-matched population, and worse than patients discharged following a conf irmed myocardial infarction. Almost half of those with ECG changes at the t ime of their admission died over the next 5 years. As over half of all deat hs in this cohort were due to cardiovascular causes, further work is needed to identify patients at high and low risk of subsequent mortality who may warrant investigation and treatment following hospital discharge. (C) 2000 European Society of Cardiology.