Rev Assoc Med Bras (1992). 2026 Aug 10;72(6):e20251775. doi: 10.1590/1806-9282.20251775. eCollection 2026.
ABSTRACT
INTRODUCTION: Around 30% of patients with acute myocardial infarction do not report chest pain, but data on symptom patterns according to the type of myocardial infarction and attending physician specialty are scarce.
OBJECTIVE: The aim of this study was to identify common clinical presentations of acute myocardial infarction in a Brazilian registry, stratified by infarction type and physician specialty.
METHODS: Observational analysis of two datasets: (1) retrospective cohort of 2,783 acute myocardial infarction patients from 15 hospitals (2014-2018) initially evaluated by emergency physicians; (2) prospective registry of 718 acute myocardial infarction patients (2018-2020) assessed in the acute phase by cardiologists via telemedicine. Cases were classified as ST-segment Elevation Myocardial Infarction or Non-ST-segment Elevation Myocardial Infarction. Symptoms were categorized as typical/atypical chest pain, epigastric pain, or absence of both; additional symptoms were recorded. Categorical variables were compared using chi-square tests (p<0.05).
RESULTS: Typical chest pain occurred in 60.3% of patients, more frequent in ST-segment Elevation Myocardial Infarction than Non-ST-segment Elevation Myocardial Infarction (66.5 vs. 56.5%; p<0.01). Absence of chest/epigastric pain was more common in Non-ST-segment Elevation Myocardial Infarction (6.1%) than ST-segment Elevation Myocardial Infarction (2.7%) (p<0.01). Cardiologist assessment identified more acute myocardial infarction cases without chest/epigastric pain than emergency physician assessment (11.0 vs. 3.2%; p<0.01). ST-segment Elevation Myocardial Infarction patients without chest/epigastric pain had the highest mortality (29.4%) in the emergency physician cohort.
CONCLUSION: In this registry, absence of chest or epigastric pain was less frequent than previously reported but associated with high mortality. Telemedicine evaluation by cardiologists identified a greater proportion of pain-free acute myocardial infarction presentations.
CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT02753023.
PMID:42585422 | DOI:10.1590/1806-9282.20251775