What is the chief complaint of patients hospitalized with a first myocardial infarction?

Chest pain appears to be the principal complaint of patients hospitalized with a first myocardial infarction (MI), particularly among those in the youngest age group, a study has found.

The investigators sought to describe age differences in patients’ chief complaint associated with a first MI and how the “typicality” of acute symptoms related to the extent of prehospital delay. To do this, they reviewed the medical records of 2,586 residents of central Massachusetts, hospitalized at 11 greater Worcester medical centres with a first MI, on a biennial basis between 2001 and 2011.

Of the patients (mean age, 39.6 percent; 39.6 percent women), 40.2 percent were diagnosed with ST-elevation MI (STEMI) and 72.0 percent presented with typical symptoms of MI, namely acute chest pain or pressure. They were further categorized into five age strata: <55 years (23 percent), 55-64 years (20 percent), 65-74 years (19 percent), 75-84 years (22 percent), and ≥85 years (16 percent).

Atypical symptoms of MI were least observed in patients aged <55 years at 11 percent, increasing to 17 percent, 28 percent, 40 percent, and 51 percent across the respective age groups. At the time of hospitalization, chest pain turned out to be the most frequent chief complaint. However, the number of patients reporting this symptom fell from the youngest (83 percent) to the oldest groups (45 percent).

Furthermore, a slightly elevated risk of prehospital delay across the different age groups (higher in the oldest old) was observed in those who presented with atypical, rather than typical, symptoms of MI.