PMID- 34815999
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220428
IS  - 2352-9067 (Print)
IS  - 2352-9067 (Electronic)
IS  - 2352-9067 (Linking)
VI  - 37
DP  - 2021 Dec
TI  - Association between pre-hospital chest pain severity and myocardial injury in ST 
      elevation myocardial infarction: A post-hoc analysis of the AVOID study.
PG  - 100899
LID - 10.1016/j.ijcha.2021.100899 [doi]
LID - 100899
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.
CI  - (c) 2021 Published by Elsevier B.V.
FAU - Fernando, Himawan
AU  - Fernando H
AD  - Department of Cardiology, Alfred Hospital, Melbourne, Australia.
AD  - Baker Heart and Diabetes Institute, Melbourne, Australia.
FAU - Nehme, Ziad
AU  - Nehme Z
AD  - Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia.
AD  - Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, 
      Australia.
AD  - Department of Community Emergency Health and Paramedic Practice, Monash 
      University, Melbourne, Australia.
FAU - Peter, Karlheinz
AU  - Peter K
AD  - Department of Cardiology, Alfred Hospital, Melbourne, Australia.
AD  - Baker Heart and Diabetes Institute, Melbourne, Australia.
FAU - Bernard, Stephen
AU  - Bernard S
AD  - Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia.
AD  - Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, 
      Australia.
FAU - Stephenson, Michael
AU  - Stephenson M
AD  - Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia.
AD  - Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, 
      Australia.
FAU - Bray, Janet E
AU  - Bray JE
AD  - Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia.
AD  - Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, 
      Australia.
FAU - Myles, Paul S
AU  - Myles PS
AD  - Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, 
      Australia.
AD  - Department of Anaesthesiology and Perioperative Medicine, The Alfred and Monash 
      University, Australia.
FAU - Stub, Romi
AU  - Stub R
AD  - Department of Anaesthesiology and Perioperative Medicine, The Alfred and Monash 
      University, Australia.
FAU - Cameron, Peter
AU  - Cameron P
AD  - Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia.
AD  - Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, 
      Australia.
FAU - Ellims, Andris H
AU  - Ellims AH
AD  - Department of Cardiology, Alfred Hospital, Melbourne, Australia.
FAU - Taylor, Andrew J
AU  - Taylor AJ
AD  - Department of Cardiology, Alfred Hospital, Melbourne, Australia.
FAU - Kaye, David M
AU  - Kaye DM
AD  - Department of Cardiology, Alfred Hospital, Melbourne, Australia.
AD  - Baker Heart and Diabetes Institute, Melbourne, Australia.
FAU - Smith, Karen
AU  - Smith K
AD  - Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia.
AD  - Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, 
      Australia.
FAU - Stub, Dion
AU  - Stub D
AD  - Department of Cardiology, Alfred Hospital, Melbourne, Australia.
AD  - Baker Heart and Diabetes Institute, Melbourne, Australia.
AD  - Department of Cardiology, Western Health, Melbourne, Australia.
LA  - eng
PT  - Journal Article
DEP - 20211108
PL  - Ireland
TA  - Int J Cardiol Heart Vasc
JT  - International journal of cardiology. Heart & vasculature
JID - 101649525
PMC - PMC8591354
OTO - NOTNLM
OT  - Chest pain predictors
OT  - Infarct size
OT  - Myocardial infarction
OT  - Opioid analgesia
OT  - Pain severity
COIS- The authors declare that they have no known competing financial interests or 
      personal relationships that could have appeared to influence the work reported in 
      this paper.
EDAT- 2021/11/25 06:00
MHDA- 2021/11/25 06:01
PMCR- 2021/11/08
CRDT- 2021/11/24 06:35
PHST- 2021/09/30 00:00 [received]
PHST- 2021/10/14 00:00 [revised]
PHST- 2021/10/17 00:00 [accepted]
PHST- 2021/11/24 06:35 [entrez]
PHST- 2021/11/25 06:00 [pubmed]
PHST- 2021/11/25 06:01 [medline]
PHST- 2021/11/08 00:00 [pmc-release]
AID - S2352-9067(21)00187-1 [pii]
AID - 100899 [pii]
AID - 10.1016/j.ijcha.2021.100899 [doi]
PST - epublish
SO  - Int J Cardiol Heart Vasc. 2021 Nov 8;37:100899. doi: 10.1016/j.ijcha.2021.100899. 
      eCollection 2021 Dec.