Key result
Cardiologist assessment via telemedicine identified more acute myocardial infarction cases without chest or epigastric pain than emergency physician assessment (11.0% vs 3.2%; p<0.01).
Why the study?
Around 30% of patients with acute myocardial infarction lack chest pain, but data on symptom patterns according to infarction type and attending physician specialty are scarce.
Does the identified clinical presentation of acute myocardial infarction differ by attending physician specialty and infarction type?
Observational (n=3,501)
Yes
Does the identified clinical presentation of acute myocardial infarction differ by attending physician specialty and infarction type?
Answers are grounded in this paper and cite their sources.
Atypical or pain-free presentations of acute myocardial infarction are more common in NSTEMI and are better identified by cardiologists via telemedicine, with pain-free STEMI carrying high mortality.
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.
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Silva et al. (2026) conducted an observational in acute myocardial infarction (n=3,501). Cardiologist assessment via telemedicine vs. Emergency physician assessment was evaluated on Identification of acute myocardial infarction cases without chest or epigastric pain (p=<0.01). Cardiologist assessment via telemedicine identified more acute myocardial infarction cases without chest or epigastric pain than emergency physician assessment (11.0% vs 3.2%; p<0.01).
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