Presenting symptoms of myocardial infarction predict short- and long-term mortality: The MONICA/KORA Myocardial Infarction Registry

Background It is unknown whether clinical outcomes differ with specific symptoms of an acute myocardial infarction (AMI). The objective of this study was to investigate the association between 13 self-reported symptoms and 28-day case fatality or long-term all-cause mortality in patients with AMI. Methods The sample consisted of 1,231 men and 415 women aged 25 to 74 years hospitalized with a first-time AMI recruited from a population-based AMI registry. Multivariable logistic regression modeling was used to assess the relationship between symptom occurrence and 28-day case fatality. Cox proportional hazards models were used to determine the effects on long-term mortality. Analyses were adjusted for sex, age, type of AMI, diabetes, prehospital delay time, and reperfusion therapy. Results The median observation time was 4.1 years (interquartile range 15 years). Twenty-eight-day case fatality was 6.1%, and long-term mortality was 10.6%. Patients who experienced fear of death (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.03-0.47), diaphoresis (OR 0.45, 95% CI 0.25-0.82), or nausea (OR 0.45, 95% CI 0.22-0.95) had a significantly decreased risk of dying within 28 days, whereas syncope (OR 5.36, 95% CI 2.65-10.85) was associated with a higher risk. A decreased risk for long-term mortality was found for people with pain in the upper abdomen (hazard ratio 0.43, 95% CI 0.19-0.97), whereas dyspnea was related to an increased risk (hazard ratio 1.50, 95% CI 1.11-2.06). The absence of chest symptoms was associated with a 1.85-fold risk for long-term mortality (95% CI 1.13-3.03). Conclusions Specific symptoms are associated with mortality. Further research is required to illuminate the reasons for this finding. (Am Heart J 2012;164:856-61.)