Document resource
Chest pain has long been considered the cardinal symptom of acute myocardial infarction (AMI) and remains the cornerstone of public awareness campaigns, emergency triage algorithms and clinical decision-making.1 Yet, a substantial proportion of patients with ST-elevation myocardial infarction (STEMI) present without chest pain (NCP). These patients frequently remain under-recognised, experience delays in diagnosis and reperfusion and receive less guideline-directed therapy.2 The clinical consequences of this previously called « atypical presentation » have been recognised for decades. In North American guidelines for the management of chest pain, a class 1 recommendation aims to eliminate the use of the term ‘atypical’ because it is not helpful in determining the cause and often leads to misinterpretation, underestimating its significance and a priori attributing to it a benign nature.3