Identifying Symptom Clusters Predictive of Acute Myocardial Infarction for Aboriginal and Torres Strait Islander and
Jaimi Greenslade1,2, William Parsonage3,4, Laura Stephensen2,3
1School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Turrbal and Yuggera Country, Queensland, Australia.
Objectives:
This study examines the symptoms experienced by patients investigated for Acute Coronary Syndrome (ACS). It aims to determine whether symptom clusters exist, whether these predict acute myocardial infarction (AMI), and whether symptom patterns differ between Aboriginal and Torres Strait Islander people and non-Indigenous Australians.
Methods:
This analysis of the LEGEND trial included 2185 patients (22.7% of whom identified as Aboriginal and Torres Strait Islander). Data on presenting symptoms and outcomes were collected from patient medical records. Regression analyses examined whether individual symptoms predicted AMI for Aboriginal and Torres Strait Islander and non-Indigenous patients. Factor analysis identified symptom clusters. Regression analyses estimated the associations between each symptom cluster and AMI.
Results:
Six symptom clusters were identified: pleuritic, numbness, anginal, palpitations, epigastric, and infectious. Anginal was most strongly associated with AMI (Risk ratio [RR] = 1.46; 95% CI: 1.31-1.62), while pleuritic was linked to a reduced risk (RR = 0.47; 95% CI: 0.35-0.62). Numbness (RR = 1.29; 95% CI: 1.11-1.49) and infectious (RR = 1.21; 95% CI: 1.05-1.41) were associated with an increased AMI risk. There were individual symptoms that differed for Aboriginal and Torres Strait Islander patients. However, cluster-level predictive performance was similar across groups. No symptom cluster provided sufficient discriminatory power to rule in or rule out AMI.
Conclusions:
Symptom presentation in AMI is heterogeneous, and reliance on "classic" symptoms alone may miss at-risk patients. While some differences in individual symptom associations were observed for Aboriginal and Torres Strait Islander patients, overall cluster patterns were comparable.
Related Concept Videos
Acute Coronary Syndrome III: Diagnostic Studies
Acute Coronary Syndrome I: Introduction
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
Angina III: Clinical Manifestations and Assessment
Myocarditis II: Clinical Features and Diagnostic Tests
Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...

