Symptom Presentation of Acute Myocardial Infarction: Influence of Sex, Age, and Risk Factors

Objectives: The purpose of this study was to examine the symptomatology of onset of acute myocardial infarction (AMI) in patients according to sex, age, and existence of conventional risk factors.

Background: Some studies have suggested that sex and other patient characteristics may influence symptoms in AMI, but data were limited and conflicting.

Methods: This was a prospective, observational study of a large number of symptoms in 1996 patients admitted to Clinical Hospital Split between January 1990 and July 1995 as the result of a first AMI. For each patient, the structured data form covering experience of pain at 10 body locations and 11 other symptoms, baseline characteristics, risk factors, and peak cardiac enzyme levels was completed a median of 3 days after AMI.

Results: Any pain, and specifically chest pain, was more often reported by male patients, smokers, hypertensive patients, nondiabetic patients, and hypercholesterolemic patients. Women were more likely to report nonchest pain other than epigastric and right shoulder pain, as well as various nonpain symptoms. The independent predictors of atypical AMI presentation (ie, absence of pain) in both men and women were lower levels of creatine kinase-MB fraction (P <.0001 and P =.0003, respectively), diabetes mellitus (P =.0002 and P =.002, respectively), older age (P =.001 and P =.01, respectively), and absence of smoking in men (P =.005). The independent predictors of presence of nonpain symptoms in both men and women were higher levels of creatine kinase-MB fraction (P =.01 and P =.049, respectively) and diabetes mellitus (P =.048 and P =.005, respectively); in men, it was hypercholesterolemia (P =.01).

Conclusions: Our results suggest that sex, age, smoking, hypertension, diabetes, and hypercholesterolemia may affect the symptoms in AMI. Women with diabetes represent a high-risk subgroup for painless onset followed by various other symptoms.