Myocardial infarction: patients sent home were more likely to die. | 
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Lee et al:
American Journal of Cardiology
1987;
60:
219-224
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Expires March 2003 | |
The study
Case-control study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.Setting: emergency department, 6 acute hospitals, USA
1283 patients (aged mean 56 years, 75% male) anterior, precordial or left-sided chest pain who were discharged from the emergency department following work-up.
Excluded if
- local trauma
- abnormalities on CXR
- <25
Cases: 35 patients (75% male, mean age 56): diagnosed with MI on follow-up: characteristic evolution of cardiac enzymes including CK-MB > 5% total CK; ECG showing new q waves; scintography showing focal uptake; sudden death within 72 hours of discharge
Controls: 103 patients (75% male, mean age 56): matched for age and sex, who were admitted with MI
Logistic regression performed to adjust for confounding factors.
Outcomes studied:
- death
- 100% followed for 72 hours: 84% had repeat blood tests
The evidence
Patient expected event rate for death: .%| risk factor | death present |
death absent |
unadjusted OR (95% CI) |
NNH (95% CI) |
|---|---|---|---|---|
| missed MI | 9 | 26 | 2.45 (0.94 to 6.37) |
6 (-100 to 2) |
| no missed MI | 13 | 92 |
- Adjusting for confounding factors: OR death became significant (p < 0.001).
Comments
- Prevelance of MI varies between 15% (Lee 1985) and 30% (Lee 1987 - this paper) from the same institution. No good explanation of this is noted.
Citation
- Lee TH, Rouan GW, Weisberg MC, et al: clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room. American Journal of Cardiology 1987; 60: 219-224
Contributor: Chris Ball and Clare Wotton, March 2000
Reviewer: Dwight Peretz
Clinical Question.
| Patient | MI |
| Intervention or Exposure | sent home from emergency department |
| Outcome | mortality |
