Identifying Symptom Clusters Predictive of Acute Myocardial Infarction for Aboriginal and Torres Strait Islander and Non-Indigenous Australians.

OBJECTIVES

This study examines the symptoms experienced by patients investigated for Acute Coronary Syndrome (ACS). It aims to determine whether symptom clusters exist, whether these predict acute myocardial infarction (AMI), and whether symptom patterns differ between Aboriginal and Torres Strait Islander people and non-Indigenous Australians.

METHODS

This analysis of the LEGEND trial included 2185 patients (22.7% of whom identified as Aboriginal and Torres Strait Islander). Data on presenting symptoms and outcomes were collected from patient medical records. Regression analyses examined whether individual symptoms predicted AMI for Aboriginal and Torres Strait Islander and non-Indigenous patients. Factor analysis identified symptom clusters. Regression analyses estimated the associations between each symptom cluster and AMI.

RESULTS

Six symptom clusters were identified: pleuritic, numbness, anginal, palpitations, epigastric, and infectious. Anginal was most strongly associated with AMI (Risk ratio [RR] = 1.46; 95% CI: 1.31-1.62), while pleuritic was linked to a reduced risk (RR = 0.47; 95% CI: 0.35-0.62). Numbness (RR = 1.29; 95% CI: 1.11-1.49) and infectious (RR = 1.21; 95% CI: 1.05-1.41) were associated with an increased AMI risk. There were individual symptoms that differed for Aboriginal and Torres Strait Islander patients. However, cluster-level predictive performance was similar across groups. No symptom cluster provided sufficient discriminatory power to rule in or rule out AMI.

CONCLUSIONS

Symptom presentation in AMI is heterogeneous, and reliance on "classic" symptoms alone may miss at-risk patients. While some differences in individual symptom associations were observed for Aboriginal and Torres Strait Islander patients, overall cluster patterns were comparable.