Abstract P152: Differences in Symptom Presentation According to Type of Acute Myocardial Infarction

Abstract

Background: Chest pain/discomfort is the hallmark symptom of Acute Myocardial Infarction (AMI). An important percentage of AMI patients may not present with chest pain/discomfort. We hypothesized that the presence or absence of chest pain/discomfort at the time of admission may be influenced by the AMI classification type: ST segment elevation MI (STEMI) or Non STEMI (NSTEMI). Methods: We analyzed data from 1,143,513 AMI patients (565,195 with STEMI; 578,318 with NSTEMI) in the National Registry of Myocardial Infarction (NRMI) during the 1994-2006 period. Multivariable models were developed to examine the predictors of AMI presentation without chest discomfort by AMI type, adjusting for age, gender, ethnicity, payer status, cardiac risk factors, past medical history and past cardiac history. Results: The proportion of AMI patients who presented with chest pain was significantly higher in patients with STEMI (72.9%) than NSTEMI (56.4%) (p <0.001). Conversely, percentage of AMI patients who presented without chest pain was higher in NSTEMI (43.6%) and much lower in STEMI (27.1%) p <0.001. Multivariable analysis indicates a strong association by AMI Type. TABLE. Differences in Presentation Without Chest Pain Among Patients Diagnosed By AMI Type: NRMI, 1994-2006 Unadjusted Odd Ratio + 95 CI Adjusted Odds Ratio + 95 CI STEMI NSTEMI STEMI NSTEMI Reference 2.07 [2.06, 2.09] Reference 1.93 [1.91, 1.95] Conclusions: Hospitalized AMI patients without chest pain/discomfort were almost 2x more likely to have NSTEMI than STEMI. These findings may have important clinical implications when evaluating patients with a suspected acute coronary syndrome.