72 Primary symptoms, patient beliefs and subsequent events in ST-elevation myocardial infarction (STEMI): an analysis of 30 patients from the pathway analysis project in STEMI (PAP-STEMI) study

Introduction A common description of symptoms of ST-elevation myocardial infarction (STEMI) is left sided chest pain radiating to the throat or left arm associated with nausea and sweating. However, not all patients have chest pain and what patients think during the event and their response is not well known. This is important as patient decision making may have impact on when the decide to seek treatment. Methods Data from 30 consecutive patients in the Pathway Analysis Project in STEMI (PAP-STEMI) study was analysed. This retrospective cohort study included consecutive patients with a diagnosis of STEMI at the University Hospital St. Polten in Austria who consented to take part in the study. Data was collected from hospital records and telephone interviews and statistical analysis was performed on STATA. Results The mean age was 63±11 years and 70% of patients were men. A total of 28 out of 30 patients were Austrian and 76.7% either did not complete school or completed high school. Current smokers, patients with diabetes mellitus and previous myocardial infarction made up of 53.6%, 20.0% and 16.7% of patients respectively. All patients were revascularized with primary PCI and no patients died at 30 days. The primary symptoms of patients were chest pain (53.3%), back pain (13.3%), collapse (10.0%), generally unwell (10.0%), abdominal pain (6.7%), shoulder pain (3.3%) and left-hand pain (3.3%). At the time of the primary symptoms only 11 thought they were having a heart attack (36.7%), later two other patients had progressive symptoms and they thought they had a heart attack. Typical symptoms of STEMI with chest pain were present in 63.3% of patients and 70.0% had other atypical non-chest pain symptoms. Complex factors related to symptoms influence propensity to seek help and what the patient believed was the cause of the symptoms. Factors such as the GP surgery not being open, presence of healthcare professionals or relatives who could provide help and co-existing illness such as previous myocardial infarction and H. pylori infection impacted timeliness and method of seeking treatment. Out of the 8 patients who were reviewed by their GP before their STEMI, only half were initially correctly diagnosed. Conclusions While chest pain is the most common primary symptom in patients with STEMI, the actual symptoms are variable which can impact patient decision including actions to seek help. These important upstream events may have significant downstream consequences as patients may delay seeking help, seek help from GP or call an ambulance which would result in variable delay to diagnosis. Conflict of Interest None