Frequencies and Trends of Myocardial Infarction Symptoms From the Years 1985-2019: A Register-based, Real-world...

Our aim in this study was to identify the frequencies of typical and atypical acute myocardial infarction (AMI) symptoms over the past 35 years as well as age and sex differences.

In this study we used data from the population-based Augsburg Myocardial Infarction Registry. All patients (N = 23,905) 25-74 years of age and hospitalized with AMIs occurring between 1985 and 2019 were included in this analysis. During their hospital stay, patients were interviewed about their symptoms at the acute event and information from patient records was used. Multivariable adjusted logistic regression analyses were conducted to investigate the trends of AMI symptoms over time.

On comparing the time interval 1985-1995 vs 2006-2019, there was a decrease in frequencies (P < 0.001 for all) for symptoms of typical chest pain (83.5% vs 80.0%), pain in the left shoulder/arm/hand (52.1% vs 44.9%), pain between the shoulder blades (23.8% vs 19.5%), nausea/vomiting (36.0% vs 30.1%), and fear of death/feeling of annihilation (30.7% vs 14.7%), whereas shortness of breath increased significantly over time (43.8% vs 48.4%, P < 0.001). Multivariable logistic regression analysis confirmed the decrease of frequency of AMI symptoms over the past decades. The only exception was occurrence of shortness of breath, where a significantly independent increase was observed when comparing 1985-1995 and 2006-2019 (odds ratio 1.22, 95% confidence interval 1.13-1.32). Atypical symptoms occurred more frequently in older patients and women.

Although there has been a decrease in the frequency of most AMI symptoms over almost 4 decades, AMIs are still commonly accompanied by typical chest pain. In particular, AMI must be considered if shortness of breath is present.