Presenting complaint among patients with myocardial infarction who present to an urban, public hospital emergency department.
OBJECTIVE
We determine the frequency of patients presenting without a primary complaint of chest pain who are admitted with acute myocardial infarction (AMI) and identify factors associated with an increased risk of a presentation without chest pain.


METHODS
This was a retrospective, cross-sectional study over a 5-year period (July 1, 1993, to June 30, 1998) of patients presenting to a large urban, public hospital emergency department who were admitted and determined to have an AMI based on International Classification of Diseases, 9th Revision, coding and chart review. Main outcome measures were prevalence of presentation without chest pain and prevalence of other predefined presentations (ie, shortness of breath, cardiac arrest, abdominal pain, dizziness/weakness/syncope) as determined by the primary chief complaint entered on arrival at the ED. We calculated univariate relative risks and multivariate odds ratios (ORs) for presentation without chest pain in women, nonwhite ethnic groups, and older age groups.


RESULTS
Of the 721 cases of diagnosed AMI, 53% (380; 95% confidence interval [CI] 49% to 56%) of patients presented with chest pain. The frequency of other complaints were shortness of breath, 17% (121); cardiac arrest, 7% (50); dizziness/weakness/syncope, 4% (32); abdominal pain, 2% (14); and other, 17% (124). The risk of a presentation without chest pain in a patient with AMI increased with age. The characteristic with the highest risk for a presentation without chest pain in patients with AMI was age older than 84 years old (multivariate OR 5.76; 95% CI 3.06 to 10.83). Women were more likely than men to present without chest pain (multivariate OR 1.59; 95% CI 1.11 to 2.28).


CONCLUSIONS
Our results demonstrate that patients with AMI commonly present to the ED without a primary initial complaint of chest pain and that the frequency of initial presentations without chest pain in our urban, public hospital is as high or higher than that reported in the general ED population. Heightened awareness of atypical presentations may affect assessment of patients with AMI and provide further focus for research into presentations of acute coronary syndrome other than chest pain.
University of California-Berkeley, University of California-San Francisco Joint Medical Program, CA, USA.
Malkeet
M
Gupta
Jeffrey A
JA
Tabas
Michael A
MA
Kohn
D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002637:Chest Pain / Q000209:etiology*; D003430:Cross-Sectional Studies; D004244:Dizziness / Q000209:etiology; D004417:Dyspnea / Q000209:etiology*; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D006779:Hospitals, Public; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis; D012189:Retrospective Studies