Relationship between characters of chest pain and pre-hospital delay in patients with acute myocardial infarction: a multicenter cross-sectional study

Objective: Atypical symptoms of patients with acute myocardial infarction (AMI) are associated with more delays in care-seeking. Still, patients with typical chest pain have not received enough attention. This study aimed to investigate the effect of pain characters on pre-hospital delays in AMI patients with chest pain. Methods: Participants from the Multicenter Delay in Patients Experiencing AMI in Shanghai (MEDEA FAR-EAST) included 257 AMI patients (215 males). The data collection procedure consisted of three parts- basic epidemiological and medical information collection, bedside interview, and self-administered questionnaire. Patients were divided into two groups of persistent (n=171) or intermittent (including fluctuating, n=86) chest pain. Results: Compared with patients with persistent pain, patients with intermittent pain have longer pre-hospital delay time (PHT) and patient decision time (DT) and DT/PHT, and they had a more positive response when symptoms occur. Further multiple regression analysis showed that intermittent pain was a risk factor for the delay. And in the analysis of different subgroups of chest pain, there was a significant negative correlation between the severity of pain and the impact of pain on daily life and the delay time. Conclusions: In AMI patients, intermittent chest pain is an independent predictor of longer pre-hospital delays and should be given sufficient attention by patients and medical personnel.