Chest pain, dyspnea and other symptoms in patients with type 1 and 2 myocardial infarction. A literature review.
BACKGROUND
Some studies investigated the leading demographic and clinical characteristics of patient with type 2 myocardial infarction (MI), but a comprehensive analysis between type 1 and 2 MI patients is lacking. Therefore, we reviewed current evidence about the difference in clinical signs and symptoms at presentation in patients with type 1 and 2 MI.


METHODS
We conducted an electronic search in Medline (with PubMed interface), Scopus and ISI Web of Science using the keywords "Type(-)2" or "Type II" and "myocardial infarction" and "chest pain" and "dyspnea" in "Title/Abstract/Keywords", with no language restriction, date limited from year 2007 to present, and study cohorts including more than 400 overall cases of MI.


RESULTS
Overall, 37 documents were identified, but 33 were excluded since thoughtful comparison between the frequency of chest pain, dyspnea and other symptoms between patients with type 1 and type 2 MI was unavailable. Therefore, 4 studies were finally selected for analysis. Despite significant heterogeneity, the frequency of chest pain was consistently higher in patients with type 1 than type 2 MI (85% vs. 61%; p<0.001), whereas that of dyspnea and other symptoms was approximately 60-70% lower in type 1 than in type 2 MI. The odds ratio of chest pain was 3.5 in type 1 compared to type 2 MI, whereas that of dyspnea and other symptoms was 0.27 and 0.39 in type 1 compared to type 2 MI, respectively.


CONCLUSIONS
Our literature analysis suggests that "atypical" presentation may be more frequent in type 2 than in type 1 MI.
Section of Clinical Biochemistry, University of Verona, Verona, Italy. Electronic address: giuseppe.lippi@univr.it.
Giuseppe
G
Lippi
Research Institute Hospital 12 de Octubre ("i+12"), Madrid, Spain.
Fabian
F
Sanchis-Gomar
Emergency Department, Academic Hospital of Parma, Parma, Italy.
Gianfranco
G
Cervellin
D002637:Chest Pain / Q000453:epidemiology* / Q000209:etiology; D004417:Dyspnea / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D009203:Myocardial Infarction / Q000145:classification / Q000453:epidemiology* / Q000503:physiopathology; D016017:Odds Ratio
Chest pain; Diagnosis; Myocardial infarction; Symptoms; Type 2