Can symptom presentation predict unstable angina/non-ST-segment elevation myocardial infarction in a moderate-risk cohort?

Background: Accurate recognition of acute coronary syndromes (ACS) on initial presentation is key to minimizing morbidity and mortality. The wide spectrum of symptom presentation in ACS complicates recognition. Unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) may be particularly difficult to diagnose as patients often do not exhibit initial high-risk features, leaving the clinician with symptom presentation alone, on which to base decisions regarding further investigation and treatment.

Purpose: The aim of this study was to compare typical symptom presentation (classic description of angina) and atypical presentation in a cohort presenting with symptoms suggestive of UA/NSTEMI.

Method: A prospective cohort design was used to evaluate 100 patients enrolled in an Emergency Department Chest Pain Program.

Results: Although patients with typical presentation were more likely to have UA/NSTEMI, atypical presentation did not rule out this diagnosis. Of the 31 patients with UA/NSTEMI, most (n=23, 74.2%) had atypical symptoms. Male gender, symptom location, and history of ischemic heart disease were significantly associated with UA/NSTEMI. Of those with a final diagnosis of UA/NSTEMI, there was no difference in symptom presentation based on age or gender.

Conclusion: Clinicians should not rely on classic descriptions of angina when evaluating patients suspected of UA/NSTEMI.