Clinical presentation in EMS patients with acute chest pain in relation to sex, age and medical history: prospective cohort study

OBJECTIVE: To assess symptom presentation related to age, sex and previous medical history in patients with chest pain. DESIGN: Prospective observational cohort study. SETTING: Two-centre study in a Swedish county emergency medical service (EMS) organisation. PARTICIPANTS: Unselected inclusion of 2917 patients with chest pain cared for by the EMS during 2018. DATA ANALYSIS: Multivariate analysis on the association between symptom characteristics, patients’ sex, age, previous acute coronary syndrome (ACS) or diabetes and the final outcome of acute myocardial infarction (AMI). RESULTS: Symptomology in patients assessed by the EMS due to acute chest pain varied with sex and age and also with previous ACS or diabetes. Women suffered more often from nausea (OR 1.6) and pain in throat (OR 2.1) or back (OR 2.1). Their pain was more often affected by palpation (1.7) or movement (OR 1.4). Older patients more often described pain onset while sleeping (OR 1.5) and that the onset of symptoms was slow, over hours rather than minutes (OR 1.4). They were less likely to report pain in other parts of their body than their chest (OR 1.4). They were to a lesser extent clammy (OR 0.6) or nauseous (OR 0.6). These differences were present regardless of whether the symptoms were caused by AMI or not. CONCLUSIONS: A number of aspects of the symptom of chest pain appear to differ in unselected prehospital patients with chest pain in relation to age, sex and medical history, regardless of whether the chest pain was caused by a myocardial infarction or not. This complicates the possibility in prehospital care of using symptoms to predict the underlying aetiology of acute chest pain.