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Patient characteristics predictive for the absence of chest discomfort and the impact of the symptom type on adverse in-hospital events (all-cause mortality, cardiogenic shock, and mechanical ventilation) were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Chest discomfort was reported in 81.0%, dyspnea without chest discomfort in 12.2%, and only other symptoms in the remaining 6.9% of patients. In a multivariable regression analysis, female sex (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.035), diabetes mellitus (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), the absence of any family history of coronary artery disease (CAD) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002), anemia (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and atrial fibrillation or flutter at presentation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.017) were independent predictors for the absence of chest discomfort.\n                    <\/jats:p>\n                    <jats:p>\n                      The absence of chest discomfort was associated with a higher rate of in-hospital adverse events (10.6% for chest discomfort vs. 29.6% for dyspnea and 27.9% for other symptoms,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), which appeared partially mediated (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.044) by longer times from diagnosis to invasive management (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In type 1 NSTEMI, the absence of chest discomfort is associated with a higher rate of adverse in-hospital events. Women, diabetics, patients without a family history of CAD, patients with anemia, and patients with atrial fibrillation are more likely to present without chest discomfort and special attention may be required to avoid delayed invasive management in these patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00392-025-02628-1","type":"journal-article","created":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T10:59:46Z","timestamp":1741863586000},"page":"1723-1734","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Absence of chest discomfort in type 1 NSTEMI patients: predictors and impact on outcome"],"prefix":"10.1007","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7395-8151","authenticated-orcid":false,"given":"J. 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Michael Altstidl received speaker honorarium from Edwards Lifesciences. Luise Gaede received speaker honorarium from Abiomed, Abbott Laboratories, AstraZeneca, Boston Scientific, Edwards Lifesciences, Siemens Healthineers, SMT, and Shockwave Medical. Merve G\u00fcnes-Altan received travel support from Eli Lilly and Company. Mohamed Marwan received speaker honorarium from Edwards Lifesciences and Siemens Healthineers. Monique Tr\u00f6bs received speaker honorarium from Abbott Laboratories, Pfizer, and Bristol Myers Squibb, travel support from Abbott Laboratories and Edwards Lifesciences, and participates in the Pfizer Advisory Board. All other authors have no conflicts of interest to declare that are relevant to the content of this article.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}