Sweating: A Specific Predictor of ST‐Segment Elevation Myocardial Infarction Among the Symptoms of Acute Coronary Syndrome: Sweating In Myocardial Infarction (SWIMI) Study Group

Abstract

Background: Today, cardiologists seek to minimize time from symptom onset to interventional treatment for the most favorable results. Hypothesis: In the acute coronary syndrome (ACS) symptom complex, sweating can differentiate ST-segment elevation myocardial infarction (STEMI) from non-ST-segment elevation ACS (NSTE-ACS) during early hours of infarction. Methods: This single-center, prospective, observational study compared symptoms of STEMI and NSTE-ACS patients admitted from August 2012 to July 2014. Results: Of 12 913 patients, 90.56% met ACS criteria. Among these, 22.51% had STEMI. Typical angina was the most common symptom (83.82%). On stepwise multiple regression, sweating (odds ratio: 97.06, 95% confidence interval [CI]: 82.16-114.14, P < 0.0001) and typical angina (odds ratio: 2.72, 95% CI: 2.18-3.38, P < 0.001) had significant association with STEMI. For diagnosis of STEMI, positive likelihood ratio (LR) and positive predictive value (PPV) were highest for typical angina with sweating (LR: 11.17, 95% CI: 10.31-12.1; PPV: 76.09, 95% CI: 74.37-77.75), followed by sweating with atypical angina (LR: 3.6, 95% CI: 3.07-4.21; PPV: 50.61, 95% CI: 46.45-54.76), typical angina (LR: 1.05, 95% CI: 1.03-1.07; PPV: 22.97, 95% CI: 22.11-23.84), and atypical angina (LR: 0.77, 95% CI: 0. PPV: 18.09,). C statistic values of 0.859 for typical angina with sweating and 0.519 for typical angina alone reflected high discriminatory value of sweating for STEMI prediction. Conclusions: Presence of sweating with ACS symptoms predicts probability of STEMI, even before clinical confirmation. Sweating in association with typical or atypical angina is a much better predictor of STEMI than NSTE-ACS.

To study the correlation of symptoms of angina with the diagnosis of ST Segment Elevation Myocardial Infarction (STEMI)

“…Typical angina and sweating was found to be reliable indicator of STEMI according to one study [12]. Our findings are concurrent, with sweating distributed in frequency in second position, next to retrosternal discomfort.…”

Risk factors for ST- Elevation Myocardial Infarction in a tertiary hospital in central Nepal

“…Presence of sweating in 90.95% of STMI and only 10.43% of NSTMI has been described and sweating with ACS symptoms predicted probability of STEMI (Likelihood ratio:11.17 vs. 3.6 ). 13 Gokhroo et al 13 had described firstly as sympathetic nervous system stimulation either as pain responsive or protective response to transient stunning induced hypotension and secondly as possibility of sympathetic cross connections between sweet glands and myocardial pain fibres, which have the same origin in thoracolumbar region. Dyspnea had been present in 41% of patients which is much to the range eight to 22% in different literaturs.…”

Ischemic Heart Disease

“…Such clinical features increase the probability of a myocardial infarction in patients presenting with chest pain. Interestingly, pain radiating to both arms is the clinical feature that has the strongest positive likelihood ratio (approximately 7) for acute MI [13]. Pain that is pleuritic, sharp, or positional tends to lower the likelihood of MI as the etiology [14].…”

“…Significant hypotension may be a manifestation of MI. Diaphoresis may be present, and sweating in association with typical or atypical angina is a much better predictor of STEMI or NSTEMI than UA [13]. A third heart sound or pulmonary crackles on auscultation also would be concerning for possible MI [14].…”