Table 1.
Baseline Characteristics of the Included Studies
| Study | Country | Study Design | Data Collection | Population | Establishment of ACS | Study, y | Sample Size (Men/Women) | Mean Age Men/Women, y | Inclusion Criteria | Exclusion Criteria | Adjustments |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Tunstall‐Pedoe et al. 199618 | Scotland | Cross‐sectional | Medical records | MI | ECG changes and cardiac enzyme levels exceeding twice the upper limit of normal | 1985–1991 | 5541 (3991/1551) | 55.5/57.0 | −25 to 64 years old | None | |
| Meischke et al, 199824 | United States | Cross‐sectional | Medical records | MI | ECG changes or enzyme elevation | 1991–1993 | 4497 (2970/1527) | Median: 64/73 | – Clinically stable | – Missing symptom information | None |
| Goldberg et al, 199825 | United States | Cross‐sectional | Medical records | MI | ≥2 of the following: clinical history of chest pain, elevated serum levels of CK or LDH and ECG changes | 1986–1988 | 1360 (810/550) | 64.7/72.1 | – MI developed during surgery | Age, medical history | |
| Milner et al, 199926 | United States | Cross‐sectional | Patient interview | ACI or MI |
ACI: ECG changes and lack of cardiac enzyme elevation MI: ECG changes and cardiac enzyme elevation |
1995–1997 | 217 (127/90) | 63.0/68.8 | − Diagnosis of ACI or MI − >45 years old−18–44 years included with DM or 2 or more cardiac risk factors | Age, DM | |
| Culic et al, 20028 | Croatia | Cross‐sectional | Questionnaire | MI | ≥2 of the following: ECG changes suggestive of MI, symptoms indicating MI, increase in 1 or more cardiac enzymes | 1990–1995 | 1996 (1395/601) | 57/63 | – First‐time MI | – Previous infarctionUnable to answer questions | Age, risk factors, cardiac enzyme level |
| Grace et al, 200327 | Canada | Cross‐sectional | Patient survey | MI | Diagnosis of MI at CCU | Not described | 482 (347/135) | 59.2/66.3 | – 18 years or older | – Too ill or confused to give informed consent | None |
| Løvlien, Schei and Gjengedal, 200628 | Norway | Cross‐sectional | Questionnaire | MI | Diagnosis of MI at CCU | March–October 1999 | 82 (44/38) | Divided into age groups | −Patients up to age 65−First time MI | None | |
| Hirakawa et al, 200629 | Japan | Cross‐sectional | Medical records | MI | Diagnosis of MI in medical chart | 2001–2003 | 2221 (1712/509) | Divided into absence/presence of chest pain | – Presence or absence of chest pain unknown | None | |
| Arslanian‐Engoren et al, 200630 | United States | Cross‐sectional | Medical records | ACS | ≥2 of the following: ECG changes, increases in serum enzymes or documentation of coronary artery disease | 1999– 2004 | 1941 (1238/683) | 61/67 | – Admitted to hospital alive | – Non‐ACS presentation | Age |
| Løvlien, Schei and Hole, 20069 | Norway | Cross‐sectional | Questionnaire | MI | Elevated cardiac troponin, ECG changes and the presence of clinically appropriate symptoms | 2003–2004 | 533 (384/149) | 58.5/61.2 | −2 weeks after hospital discharge−First time MI−<76 years old | ‐ Hospitalized patients | Age |
| Dey et al, 200831 | Multinational (14 countries) | Cross‐sectional | Medical records | ACS | Clinical history of ACS accompanied by at least 1 of the following: ECG changes, increase in biochemical markers or documented coronary artery disease | 1999–2006 |
a. 43 393 (29 213/14 180) b. 1026 (682/344) |
Divided into age groups | Chest pain No chest pain | – Non‐cardiovascular cause for ACS (trauma, surgery) | None |
| Kirchberger et al, 201132 | Germany | Cross‐sectional | Patient interview | MI | According to criteria of the ESC and American College of Cardiology | 2001–2006 | 2278 (1710/568) | 59.2/62.9 | −Age 25‐74 years −Survived >24 hours with MI−First time MI | Age, hypertension, DM, comorbidity | |
| Angerud et al, 201133 | Sweden | Cross‐sectional | Medical records | MI | Typical chest pain and biomarkers. If only one of the 2 parameters was positive, ECG analysis was used. | 2000–2006 | 4028 (2805/1223) | Divided into age groups | – Age 25–74 years | ‐ Previous MI‐ Patients who were dead by the time they reached medical help | None |
| Canto et al, 201234 | United States | Cross‐sectional | Medical records | MI | Clinical presentation (ischemic symptoms) and elevated cardiac biomarker level, ECG evidence or autopsy evidence | 1994–2006 | 1 143 513 (661 932/481 581) | Divided into age groups | ‐ Secondary diagnosis of MI‐ Patients with missing information on age, sex or symptoms | Age | |
| Pelter et al, 201235 | Multinational (United States, Australia, New Zealand) | Cross‐sectional | Patient interview | ACS | Discharge diagnosis of ACS in medical record | 2001–2004 | 331 (211/110) | Divided into age groups | −Prior diagnosis of coronary artery disease | ‐ Serious comorbidity‐Untreated malignancy or neurologic disorder‐Major hearing loss | None |
| O'Donnell et al, 201236 | Ireland | Cross‐sectional | ACS response to symptoms index | ACS | Discharge diagnosis of ACS | 2007–2009 | 1947 (1402/545) | Divided into age groups | −Admitted through ED−Clinically stable | – Cognitive impairment | Age, BMI, DM, comorbidity, smoking |
| Zevallos et al, 201237 | Puerto Rico | Cross‐sectional | Medical records | MI | Clinical history suggestive of AMI, serum enzyme elevations, and serial ECG findings during hospitalization. | 2007 | 1415 (778/637) | 63.2/68.6 | −Hispanic residents−First time MI | – MI secondary to interventional procedure or surgery | None |
| Coventry et al, 201338 | Australia | Cross‐sectional | Voice recordings of emergency telephone calls | MI | As defined by ICD‐10 | January 2008‐ October 2009 | 1681 (1060/621) | 69.1/77.6 | – Arrival at ED by ambulance | – Arrival by private transport or helicopter | Age |
| Melberg et al, 201339 | Norway | Cross‐sectional | Voice recordings of emergency telephone calls | STEMI | Documented ST elevation on presenting ECG, ischemic symptoms and a typical rise in serum troponin levels | 2004–2007 | 244 (179/65) | Median: 62/67 | – First contact with healthcare system by 113 phone call | None | |
| Khan et al, 201340 | Multinational (Canada, United States, Switzerland) | Cross‐sectional | McSweeney symptom survey | ACS |
1. Signs and symptoms 2. One of the following: a) ECG changes or b) increase in cardiac enzyme levels (troponin I or T, or CK‐MB, or CPK) |
2009–2012 | 1015 (710/305) | Median: 49.0/49.0 |
‐ 55 years or younger ‐ Admitted to CCU, ICU or cardiology ward |
None | |
| Asgar Pour et al, 201541 | Iran | Cross‐sectional | ACS symptom checklist | ACS | ECG changes (ST‐segment and T‐wave changes) and cardiac enzyme (CK‐MB) | Not mentioned | 320 (183/137) | 60.92/63.29 | – Admitted with at least 1 typical symptom(chest pain/pressure/heaviness/tightness, diaphoresis, dyspnea, arm pain) or atypical symptom (palpitation, vomiting, dizziness, fatigue, indigestion) | – History of stroke, neurologic disorders, COPD, pneumonia or pulmonary embolism | None |
| DeVon et al, 201742 | United States | Cross‐sectional | ACS symptom checklist | ACS | Evidence of ischemia on ECG or elevated troponin level | 2011–2014 | 474 (343/131) | 59.5/61.3 | – Admitted through ED | – Cognitive impairment | Age, African American race, comorbidity |
| Lichtman et al, 201843 | United States | Cross‐sectional | Patient interview | MI |
1. Increased cardiac biomarker levels 2. Symptoms of ischemia or ECG changes |
2008–2012 | 2985 (976/2009) | 47.2/47.1 |
– Between 18 and 55 years old –<24 hours since event –2:1 female enrollment |
None | |
| Sederholm Lawesson et al, 201810 | Sweden | Cross‐sectional | Questionnaire | STEMI | ST elevation on ECG and diagnosis of acute MI at discharge | 2012–2014 | 532 (406/126) | 64.3/69.7 |
– Patients with STEMI –Clinically stable –<24 hours since event |
Age, level of education, smoking status, comorbidity | |
| Allana et al, 201844 | Pakistan | Cross‐sectional | Response to Symptoms Questionnaire + interview | ACS | Troponin values and ECG changes | 3‐mo period | 249 (133/116) | 56.5/55.8 |
– Clinically stable – <72 hours since event |
– Cognitive or mental impairment | None |
| An et al, 20183 | China | Cross‐sectional | McSweeney symptom survey + interview | ACS | As defined by ICD‐10 | 2013–2014 | 806 (323/483) | 59.2/63.9 | –First ACS event | – Cognitive or mental impairment | Age, DM, smoking |
| Plaza‐Martin et al, 201945 | Spain | Cross‐sectional | Medical record | ACS | According to ESC guidelines | January–August 2017 | 1056 (749/307) | 64.0/71.0 | – Above 18 years of age |
– Type 2 or type 4 MI – Evident secondary cause of myocardial ischemia |
None |
ACS indicates acute coronary syndrome; ACI, acute coronary ischemia; BMI, body mass index; CCU, coronary care unit; CK‐MB, creatinine kinase‐MB; COPD, chronic obstructive pulmonary disorder; CPK, creatinine phosphokinase; DM, diabetes mellitus; ED, emergency department; ESC, European Society of Cardiology; ICD‐10, International Classification of Diseases, Tenth Revision; ICU, intensive care unit; LDH, lactate dehydrogenase; AMI, acute myocardial infarction; MI, myocardial infarction; STEMI, ST‐segment–elevation myocardial infarction.