Differential Symptoms of Acute Myocardial Infarction in Patients With Kidney Disease: A Community-Wide Perspective

Background: Patients seeking care for acute myocardial infarction (AMI) present with multiple symptoms. The objectives of our community-wide study are to examine the symptom profile of patients with, as compared with those without, kidney disease who present to the hospital with independently confirmed AMI. Methods: The symptom profile of 4,482 patients from the Worcester, MA, metropolitan area hospitalized with independently validated AMI at all 11 area medical centers during the 4 study years of 1997, 1999, 2001, and 2003 was examined. Factor analysis was used to aggregate the relevant symptoms of AMI. Logistic regression analysis was used to examine differences in symptoms of AMI according to the presence of kidney disease while controlling for several potentially confounding demographic and clinical factors. Results: Patients with kidney disease were less likely to report chest pain (adjusted odds ratio, 0.57; 95% confidence interval, 0.46 to 0.70), arm pain (odds ratio, 0.52; 95% confidence interval, 0.42 to 0.64), shoulder pain (odds ratio, 0.53; 95% confidence interval, 0.40 to 0.72), or neck pain (odds ratio, 0.54; 95% confidence interval, 0.41 to 0.70), while being more likely to report shortness of breath (odds ratio, 1.35; 95% confidence interval, 1.13 to 1.62), in comparison to patients without kidney disease in the setting of AMI. Conclusion: Kidney disease impacts on the manner in which patients present with AMI. Although patients with kidney disease are at known increased risk for several diseases, this study suggests that kidney disease also might change how these patients experience these diseases, including acute coronary disease.