Prodromal symptoms and the care-seeking behavior in patients with acute ST-segment elevation myocardial infarction

The prodromal symptoms perceived by patients before the onset of acute myocardial infarction (AMI) are diverse and not necessarily limited to the typical symptoms of angina.

Among 3959 consecutive patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention within 24 h of the onset of AMI enrolled in the CREDO-Kyoto AMI registry wave-2, the patients were categorized into 3 groups by the symptoms before the onset and within 48 h before the index hospital presentation: (1) prodromal symptoms typical of angina (N = 865, 21.8 %), (2) atypical prodromal symptoms only (N = 156, 3.9 %), and (3) no prodromal symptoms (N = 2938, 74.2 %). We investigated the association between the types of the prodromal symptoms and long-term clinical outcomes as well as the prevalence of seeking medical care for the prodromal symptoms.

As compared with patients with no prodromal symptoms, those with typical prodromal symptoms had a lower mortality risk [adjusted hazard ratio (HR): 0.69, 95 % confidence interval (CI): 0.58-0.83, p = 0.0001], whereas those with atypical prodromal symptoms only had a higher mortality risk (HR: 1.53, 95 % CI: 1.17-2.00, p = 0.002). Regarding healthcare-seeking behavior, 162 out of 1021 patients (15.9 %) with the prodromal symptoms sought medical care for the prodromal symptoms. There was no significant difference in the rate of seeking medical care between the patients with typical prodromal symptoms and atypical prodromal symptoms only (15.5 % and 17.9 %, p = 0.44).

Compared to patients with no prodromal symptoms before STEMI, long-term mortality outcome was better in patients with typical prodromal symptoms, but worse in those with atypical prodromal symptoms.