The Duration of Presenting Symptoms Does Not Aid in the Diagnosis of Acute Myocardial Infarction
Hrabec D, Solomon R, McCord J, Hudson M, Moyer M, and Nowak R. The duration of presenting symptoms does not aid in the diagnosis of acute myocardial infarction. Acad Emerg Med 2017; 24:S88-S89.
Acad Emerg Med
Background: In the ED inquiring about the duration of presenting symptoms is commonly done when evaluating patients with suspected acute myocardial infarction (AMI) as it is thought to help distinguish between an AMI and non-AMI diagnosis (long duration thought to be less likely AMI). Methods: In a single urban center, 569 patients who were clinically evaluated in the ED from May, 2013 to April, 2015 for suspected AM were prospectively studied. Patients were asked by trained research personnel the duration of their predominant presenting symptom. The diagnosis of AMI was adjudicated by two independent physicians (with a third used if there was disagreement) in accordance with the 3rd universal definition of AMI and using the clinically available Siemens Ultra troponin I values (99th% 0.04ng/ml). Patients with ECG findings that led to immediate reperfusion were excluded from the study.
Results: There were 569 patients enrolled into the study and 45 (7.9%) had an adjudicated AMI. The presenting symptoms were comprised of chest pain 485 (84.9%), shortness of breath 50 (8.8%), palpitations 14 (2.5%) syncope 6 (1.1%), dizzy/lightheaded 6 (1.12%), epigastric/abdominal pain 5 (0.9%) and other 3 (0.5%). The mean duration of symptoms in the 45 AMI patients was 14.2 hours (± 33 hours) and in the 524 non-AMI individuals 17.9 hours (± 54.2 hours) (p=0.307). Additionally, analysis of the duration of the presenting predominant symptom in discrete time intervals (0-4 min, 4-19 min, 20-59 min, 1.0-2.9 hours, 3.0 -5.9 hours and > 6 hours) did not show a significant difference between AMI and non-AMI patients (p=0.511).
Conclusions: The duration of the presenting predominate symptom, chest pain or otherwise, does not help identify those patients having an AMI. Other elements of the symptom history of an ED patient with suspected AMI should therefore be used in helping differentiate AMI from non AMI.