Association between acute myocardial infarction symptoms and short- and long-term mortality after the event.

BACKGROUND:In this study we investigated the associations between various acute myocardial infarction (AMI) symptoms and their associations with short-term (28 day) - and long-term mortality. METHODS:The analysis was based on 5,900 patients aged 25 to 84 years with a first-time AMI recorded by the population-based Myocardial Infarction Registry Augsburg between 2010 and 2017. Median follow-up time was 3.8 years [IQR: 1.1-6.3]. As part of a face-to-face interview, the presence (yes/no) of 11 most commonly AMI symptoms at the acute event was assessed. Using multivariable-adjusted logistic regression and COX regression models the association between various symptoms and all-cause mortality was investigated. P values of the regression models were FDR-adjusted. RESULTS:Pain in various body parts (chest pain, left and right shoulder/arm/hand, between shoulder blades), sweating, nausea/vomiting, dizziness and fear of death/feeling of annihilation were significantly associated with a decreased 28-day mortality after AMI. The pain symptoms and sweating were also significantly associated with a decreased long-term mortality. Shortness of breath was significantly associated with a higher long-term mortality. CONCLUSIONS:The absence of several symptoms, including typical chest discomfort (chest pain or retrosternal pressure/tightness), is associated with unfavorable outcomes after AMI. This finding has implications for patient management and public health measures designed to encourage appropriate and prompt medical consultation of patients with atypical AMI symptoms.