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Many Heart Attack Patients Do Not Have Chest Pain CHICAGO, IL -- June 27, 2000 -- A substantial number of people who have a heart attack do not have chest pain and therefore delay seeking care, according to an article appearing in the June 28 issue of The Journal of the American Medical Association (JAMA). After arrival at the hospital, these patients were less likely to receive important therapies and they had worse outcomes than their counterparts with chest pain. John G. Canto, M.D., M.S.P.H., from the University of Alabama at Birmingham, and colleagues analyzed records in the National Registry of Myocardial Infarction 2 of 434,877 patients with confirmed myocardial infarction to determine the frequency of myocardial infarction without chest pain. "Of all patients diagnosed as having [myocardial infarction], 142,445 (33 percent) did not have chest pain on presentation to the hospital," the researchers write. "This group of [myocardial infarction] patients was, on average, seven years older than those with chest pain (74.2 vs. 66.9 years), with a higher proportion of women (49.0 percent vs. 38.0 percent) and patients with diabetes mellitus (32.6 percent vs. 25.4 percent) or prior heart failure (26.4 percent vs. 12.3 percent). Also, [myocardial infarction] patients without chest pain had a longer delay before hospital presentation (mean, 7.9 vs. 5.3 hours), were less likely to be diagnosed as having confirmed [myocardial infarction] at the time of admission (22.2 percent vs. 50.3 percent), and were less likely to receive thrombolysis or primary angioplasty (25.3 percent vs. 74.0 percent), aspirin (60.4 percent vs. 84.5 percent), beta-blockers (28.0 percent vs. 48.0 percent) or heparin (53.4 percent vs. 83.2 percent). Myocardial infarction patients without chest pain had a 23.3 percent in-hospital mortality rate compared with 9.3 percent among patients with chest pain [more than two times the risk of death occurring in the hospital]." In the study, chest pain was defined as any symptom of chest discomfort, sensation or pressure, or arm, neck or jaw pain occurring before hospital arrival or before a diagnosis of acute myocardial infarction. Those without chest pain were admitted for a variety of reasons including shortness of breath, nausea/vomiting, palpitations, faintness or loss of consciousness or cardiac arrest. According to background information in the article, chest pain is the principle feature in the diagnosis of myocardial infarction, yet not all patients with myocardial infarction experience chest pain. "National public health care initiatives that educate the public and medical professionals must emphasize that the presence of chest pain is not necessarily a hallmark feature in [myocardial infarction], and should incorporate other features of [myocardial infarction] to facilitate a more expedient recognition and treatment of [myocardial infarction] in the absence of chest pain," recommend the researchers. "Earlier recognition of this fact may allow high-risk patient groups to consider presenting earlier to the medical establishment and medical professionals to identify such patients so that they may receive timely diagnostic and therapeutic interventions known to improve survival. Additional studies are needed to prospectively and accurately identify [myocardial infarction] patients without chest pain." (JAMA. 2000;283:3223-3229) Related Link: The Journal of the American Medical Association (JAMA). E-mail this page to a friend or colleague! To print, use this version