Frequency and Demographic Distribution of Atypical Presentation among Patients with Acute Coronary Syndrome Presenting to a Tertiary Cardiac Center in Multan
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Background: Acute coronary syndrome commonly presents with chest discomfort, but a clinically important proportion of patients present with dyspnea, fatigue, epigastric discomfort, nausea, syncope, dizziness, back pain, or silent ischemia, which may delay recognition and treatment. Objective: To determine the frequency of atypical presentation among patients with acute coronary syndrome and assess its distribution across demographic and clinical groups. Methods: This descriptive cross-sectional study was conducted at Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, from December 2024 to May 2025. A total of 216 adults with confirmed acute coronary syndrome were enrolled by non-probability consecutive sampling. Atypical presentation was defined as atypical chest pain, dyspnea, fatigue, abdominal or epigastric pain, back pain, dizziness, syncope, nausea or vomiting, or silent acute coronary syndrome. Data were analyzed using SPSS version 26. Results: Atypical presentation was recorded in 62 patients, giving a frequency of 28.7% (95% CI: 23.1–35.1). It was more frequent in patients aged >65 years than younger patients, 52.6% versus 23.6% (p<0.001), in females than males, 39.7% versus 23.1% (p=0.016), and in diabetic patients than non-diabetic patients, 37.5% versus 23.5% (p=0.042). NSTEMI had a higher atypical presentation frequency than STEMI and unstable angina, 38.3%, 21.2%, and 26.0%, respectively (p=0.046). In multivariable analysis, age >65 years, female gender, diabetes mellitus, and NSTEMI diagnosis remained independently associated with atypical presentation. Dyspnea was the commonest atypical symptom. Conclusion: Almost one-third of patients with acute coronary syndrome presented atypically. Older age, female gender, diabetes mellitus, and NSTEMI were independently associated with atypical presentation. Emergency cardiac assessment should maintain a low threshold for electrocardiography and troponin testing in high-risk patients even when classical chest pain is absent.
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