Is duration of symptoms predictive of acute myocardial infarction?
Solomon R, Nowak R, Hudson M, Moyer M, McCord J. Is duration of symptoms predictive of acute myocardial infarction? J Am Coll Cardiol. Mar 2017;69(11):247-247.
J Am Coll Cardiol
Background: Patient interviews regarding the duration of symptoms are commonly conducted when evaluating a patient with possible acute myocardial infarction (AMI), and are believed to distinguish between AMI and non-AMI symptoms. Methods: In a single center, 569 patients that were evaluated in the emergency department (ED) for possible AMI from 5/2013 to 4/2015 were prospectively studied. Patients in the ED were asked by trained research personnel what was the longest duration of their predominant symptom. Diagnosis of AMI was adjudicated by 2 independent physicians in accordance with the universal defnition of AMI using all clinical information and required cTnI > 0.04 ng/ml (Siemens Ultra-cTnI). In situations where there was disagreement between the adjudicators, a third adjudicator reviewed the case for fnal determination of AMI. Patients with ECG fndings that led to immediate reperfusion were excluded. Results: There were 45 (8%) AMIs and 484 (85%) had chest pain as their predominant symptom. In those diagnosed with AMI, the mean duration of symptoms was 14.2 ± 33 hrs as compared to 17.9 ± 54.2 hrs in the 524 non-AMI patients (p=0.307). Looking at duration of symptoms in discrete time intervals also did not show a signifcant difference between AMI and non-AMI patients. Conclusions: Duration of symptoms did not help distinguish between AMI and non-AMI patients. Clinicians should focus on other elements of the history when evaluating patients with possible AMI.