Predictors of high risk of atypical clinic of myocardial infarction

Objective: analysis of predictors allowing to predict a high probability of atypical clinical course of myocardial infarction (MI) at an early stage of development of acute coronary insufficiency before complex diagnostic procedures.Materials and methods: the study included patients from the Tomsk population with confirmed MI in the period 2001–2017, registered in the database "Register of Acute Myocardial Infarction" (ROIM) (n=7775). In 79.6% (n=6188), the clinical picture of MI was characterized by typical manifestations in the form of a prolonged angina attack (group 1), in the remaining 20.4%; patients (n=1587) recorded atypical manifestations of MI (group 2).Results: patients with atypical clinical manifestations of MI were more often represented by women, had an older age and a burdened comorbid background. The anamnesis of IM and coronary artery revascularization were more commonly recorded in a cohort of patients with typical clinical manifestations of coronary catastrophe. All parameters that demonstrated significant differences in patients with different types of clinical flow IM were included in the logistic regression model. As a result of a step-by-step procedure for elimination of factors, independent associations with the development of atypical symptoms of acute MI showed the following indicators: female sex, elderly age, IM history, type 2 diabetes mellitus, history of myocardial revascularization, atrial fibrillation, alcohol consumption before MI, obesity, smoking.Conclusion: female gender, elderly age, the presence of atrial fibrillation, diabetes mellitus, obesity and condition after alcohol intoxication predisposes to atypical acute MI, whereas male gender transferred to IM or revascularization, as well as smoking are currently more common in patients with a typical clinical pattern.