Abstract 13875: Poorer Outcome of Patients with Acute Myocardial Infarction and Atypical Symptoms in the Emergency Department

Abstract

Purpose: Acute myocardial infarction (AMI) is associated with the chief complaint chest pain but patients present with a variety of different symptoms. We analyzed data of all patients with a final diagnosis of AMI who initially presented to one of two Emergency Departments (EDs) over a one-year period to evaluate the association of the patient’s chief complaint at admission and in-hospital outcome. Hypotheses: Presentation to the ED with atypical symptoms has an unfavourable impact on in-hospital outcome

Methods: Data were retrieved from the hospital information system for a secondary analysis. All inpatients who had presented to one of the two EDs and who were assigned a main hospital diagnosis of ICD-9 I21 (AMI) were included in this analysis. Chief complaints (chest pain, dyspnoea, abdominal pain, and “none of these symptoms”) were documented by the treating physician in the ED in a mandatory field of the electronic ED form.

Results: Of 13,536 inpatients, 624 (4.6%) had a main hospital diagnosis of AMI. Their median age was 68 (59/76), 66.7% were male. Of all patients with AMI, 64.4% presented to the ED with a chief complaint of chest pain, 12.7% with dyspnoea, 1% with abdominal pain and 21.8% with "none of these symptoms". Compared to AMI patients presenting with chest pain, waiting times in the ED were significantly longer for AMI patients with "none of these symptoms" (p<0.0001) and dyspnoea (p=0.22) at admission. In-hospital fatality rate of the AMI patients was 6.3%. Fatality rates significantly differed between the symptom groups. Of the AMI patients who presented with chest pain, 3% died during the hospital stay as opposed to 13.9% with dyspnoea and 11.8% with none of these symptoms (p<0.0001 for both).

Conclusions: AMI patients presenting to the ED with dyspnoea and unspecified symptoms had longer waiting times and an increased in-hospital mortality rate. Workflows for the evaluation of ACS need to draw special attention to patients with atypical symptoms.