[Myocardial infarction--symptoms and procedures. Longitudinal observation of a population of 280,000 women and men--Project POL-MONICA Krakow. V. Atypical symptoms and prognosis in myocardial infarction].

There is some evidence in Poland, that percent of hospitalized coronary heart disease events with no typical pain for myocardial infarction (MI) increased. The purpose of the paper was to assess in the observational study whether the lack of typical pain in MI effects the risk of death in the acute phase. There were 1815 events, registered in POL-MONICA Kraków Project, with clinical diagnosis of MI or acute coronary heart disease, which were classified as "definite MI" or "possible MI" according to the criteria of The WHO MONICA Project, which were included to the analysis. Typical pain occurred in 1693 (93%) events and atypical symptoms in 122 (7%) events. Shock and left ventricular failure (LVF) were observed more frequently in patients with atypical symptoms who also were treated more frequently with diuretics, inotropic agents, antiarrythmics and more frequently received thrombolytic treatment. Patients with atypical symptoms had higher risk of death. Relative risk was 3.65 (95% confidence interval: 2.45-5.44). After adjustment for age, sex, shock, LVF and diabetes relative risk decreased to 1.67 (95% confidence interval: 1.10-2.54) and after inclusion of treatment to the analysis relative risk decreased to 1.58 (95% confidence interval: 1.04-2.39). The results suggest that lack of typical pain in MI can be related to worse prognosis and it should lead to more careful consideration of the treatment.