• Mayra Tisminetzky, Jerry H Gurwitz, Ruben Miozzo, Anthony Nunes, Joel M Gore, Darleen Lessard, Jorge Yarzebski, Edgard Granillo, and Robert J Goldberg.
• Meyers Primary Care Institute, Worcester, Mass; Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Mass; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass. Electronic address: mayra.tisminetzky@umassmed.edu.
• Am. J. Med. 2020 Sep 1; 133 (9): e501-e507.

BackgroundThis study set out to describe age differences in patient's chief complaint related to a first myocardial infarction and how the "typicality" of patient's acute symptoms relates to extent of prehospital delay.MethodsThe medical records of 2586 residents of central Massachusetts hospitalized at 11 greater Worcester medical centers with a first myocardial infarction on a biennial basis between 2001 and 2011 were reviewed.ResultsThe average age of the study population was 66.4 years, 39.6% were women, 40.2% were diagnosed with a ST-elevation myocardial infarction (STEMI), and 72.0 % presented with typical symptoms of myocardial infarction, namely acute chest pain or pressure. Patients were categorized into 5 age strata: >55 years (23%), 55-64 years (20%), 65-74 years (19%), 75-84 years (22%), and ≥85 years (16%). The lowest proportion (11%) of atypical symptoms of myocardial infarction was observed in patients <55 years, increasing to 17%, 28%, 40%, and 51% across the respective age groups. The most prevalent chief complaint reported at the time of hospitalization was chest pain, but the proportion of patients reporting this symptom decreased from the youngest (83%) to the oldest patient groups (45%). There was a slightly increased risk of prehospital delay across the different age groups (higher in the oldest old) in those who presented with atypical, rather than typical, symptoms of myocardial infarction.ConclusionsThe present results provide insights to the presenting chief complaint of patients hospitalized with a first myocardial infarction according to age and the relation of symptom presentation to patient's care-seeking behavior.Published by Elsevier Inc.

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