• B Lindahl, L Ljung, J Herlitz, J Alfredsson, D Erlinge, T Kellerth, E Omerovic, A Ravn-Fischer, D Sparv, T Yndigegn, P Svensson, O Östlund, T Jernberg, S K James, R Hofmann, and DETO2X-SWEDEHEART Investigators.
• Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
• J. Intern. Med. 2021 Aug 1; 290 (2): 359-372.

BackgroundCharacteristics and prognosis of patients admitted with strong suspicion of myocardial infarction (MI) but discharged without an MI diagnosis are not well-described.ObjectivesTo compare background characteristics and cardiovascular outcomes in patients discharged with or without MI diagnosis.MethodsThe DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial compared 6629 patients with strong suspicion of MI randomized to oxygen or ambient air. The main composite end-point of this subgroup analysis was the incidence of all-cause death, rehospitalization with MI, heart failure (HF) or stroke during a follow-up of 2.1 years (median; range: 1-3.7 years) irrespective of randomized treatment.Results1619 (24%) received a non-MI discharge diagnosis, and 5010 patients (76%) were diagnosed with MI. Groups were similar in age, but non-MI patients were more commonly female and had more comorbidities. At thirty days, the incidence of the composite end-point was 2.8% (45 of 1619) in non-MI patients, compared to 5.0% (250 of 5010) in MI patients with lower incidences in all individual end-points. However, for the long-term follow-up, the incidence of the composite end-point increased in the non-MI patients to 17.7% (286 of 1619) as compared to 16.0% (804 of 5010) in MI patients, mainly driven by a higher incidence of all-cause death, stroke and HF.ConclusionsPatients admitted with a strong suspicion of MI but discharged with another diagnosis had more favourable outcomes in the short-term perspective, but from one year onwards, cardiovascular outcomes and death deteriorated to a worse long-term prognosis.© 2021 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.

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