Key result
Anginal symptoms link to ~46% higher AMI risk but cannot reliably rule it in or out.
Why the study?
It was unknown whether symptom clusters predict acute myocardial infarction and whether symptom patterns differ between Aboriginal and Torres Strait Islander and non-Indigenous Australians investigated for ACS.
Do specific symptom clusters predict acute myocardial infarction in patients investigated for ACS, and do these patterns differ between Aboriginal and Torres Strait Islander and non-Indigenous Australians?
Observational (n=2,185)
Do specific symptom clusters predict acute myocardial infarction in patients investigated for ACS, and do these patterns differ between Aboriginal and Torres Strait Islander and non-Indigenous Australians?
Symptom presentation in AMI is heterogeneous, and reliance on classic symptoms alone is insufficient to rule in or rule out AMI, with similar predictive performance across Indigenous and non-Indigenous Australians.
Answers are grounded in this paper and cite their sources.
Symptom clusters should not yet guide AMI diagnosis in suspected ACS; leaves open whether ethnicity-specific patterns improve risk stratification.
OBJECTIVES: This study examines the symptoms experienced by patients investigated for Acute Coronary Syndrome (ACS). It aims to determine whether symptom clusters exist, whether these predict acute myocardial infarction (AMI), and whether symptom patterns differ between Aboriginal and Torres Strait Islander people and non-Indigenous Australians. METHODS: This analysis of the LEGEND trial included 2185 patients (22.7% of whom identified as Aboriginal and Torres Strait Islander). Data on presenting symptoms and outcomes were collected from patient medical records. Regression analyses examined whether individual symptoms predicted AMI for Aboriginal and Torres Strait Islander and non-Indigenous patients. Factor analysis identified symptom clusters. Regression analyses estimated the associations between each symptom cluster and AMI. RESULTS: Six symptom clusters were identified: pleuritic, numbness, anginal, palpitations, epigastric, and infectious. Anginal was most strongly associated with AMI (Risk ratio [RR] = 1.46; 95% CI: 1.31-1.62), while pleuritic was linked to a reduced risk (RR = 0.47; 95% CI: 0.35-0.62). Numbness (RR = 1.29; 95% CI: 1.11-1.49) and infectious (RR = 1.21; 95% CI: 1.05-1.41) were associated with an increased AMI risk. There were individual symptoms that differed for Aboriginal and Torres Strait Islander patients. However, cluster-level predictive performance was similar across groups. No symptom cluster provided sufficient discriminatory power to rule in or rule out AMI. CONCLUSIONS: Symptom presentation in AMI is heterogeneous, and reliance on "classic" symptoms alone may miss at-risk patients. While some differences in individual symptom associations were observed for Aboriginal and Torres Strait Islander patients, overall cluster patterns were comparable.
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Greenslade et al. (2026) conducted an observational in Acute Coronary Syndrome (n=2,185). Symptom clusters (e.g., anginal, pleuritic, numbness, infectious) was evaluated on Acute myocardial infarction (AMI) (RR 1.46, 95% CI 1.31-1.62). The anginal symptom cluster was most strongly associated with acute myocardial infarction (RR 1.46; 95% CI 1.31-1.62), but no cluster provided sufficient discriminatory power to rule in or out AMI.
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