Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 14, Number 2, April 2023, pages 97-105

Chest Pain in Acute Myocardial Infarction and Its Association With the Culprit Artery and Fibrotic Segment Identified by Cardiac Magnetic Resonance

Figure 1. Distribution of causes of ineligibility for the study. STEMI: ST-segment elevation myocardial infarction; CMR: cardiac magnetic resonance; MINOCA: myocardial infarction with non-obstructive coronary arteries.

Figure 2. Acute retrosternal pain and culprit coronary artery for STEMI. Three patients (A, B and C) with the same retrosternal location of pain and different obstructed coronary arteries (arrows). STEMI: ST-segment elevation myocardial infarction.

**Table 1.** Baseline Characteristics of the Study Participants
Variables	N = 223
SD: standard deviation; CMR: cardiac magnetic resonance; min: minimum; max: maximum.
Age (years)
Mean ± SD	57.2 ± 8.2
Median (min, max)	58 (35, 74)
Male sex, n (%)	161 (72.2)
Hypertension, n (%)	124 (55.6)
Diabetes mellitus, n (%)	67 (30.0)
Total cholesterol (mg/dL)
Mean ± SD	208.9 ± 47.4
Median (min, max)	201.50 (98, 361)
Low-density lipoprotein (mg/dL)
Mean ± SD	136.6 ± 40.3
Median (min, max)	132.00 (51, 258)
High-density lipoprotein (mg/dL)
Mean ± SD	42.32 ± 12.29
Median (min, max)	41.00 (18, 99)
Triglycerides (mg/dL)
Mean ± SD	164.66 ± 114.35
Median (min, max)	133.00 (42, 853)
Creatinine (mg/dL)
Mean ± SD	0.90 ± 0.22
Median (min, max)	0.87 (0.48, 1.72)
Hemoglobin (g/dL)
Mean ± SD	15.01 ± 1.67
Median (min, max)	15.00 (10.50, 20.80)
High-sensitivity cardiac troponin (pg/mL)
Mean ± SD	7,244.84 ± 5,852.58
Median (min, max)	5,695.00 (38, 32,287)
Left ventricular ejection fraction by CMR (%)
Mean ± SD	48.25 ± 11.24
Median (min, max)	48.00 (19.10, 71.90)

Table 1. Baseline Characteristics of the Study Participants

Variables

N = 223

SD: standard deviation; CMR: cardiac magnetic resonance; min: minimum; max: maximum.

Age (years)

Mean ± SD

57.2 ± 8.2

Median (min, max)

58 (35, 74)

Male sex, n (%)

161 (72.2)

Hypertension, n (%)

124 (55.6)

Diabetes mellitus, n (%)

67 (30.0)

Total cholesterol (mg/dL)

Mean ± SD

208.9 ± 47.4

Median (min, max)

201.50 (98, 361)

Low-density lipoprotein (mg/dL)

Mean ± SD

136.6 ± 40.3

Median (min, max)

132.00 (51, 258)

High-density lipoprotein (mg/dL)

Mean ± SD

42.32 ± 12.29

Median (min, max)

41.00 (18, 99)

Triglycerides (mg/dL)

Mean ± SD

164.66 ± 114.35

Median (min, max)

133.00 (42, 853)

Creatinine (mg/dL)

Mean ± SD

0.90 ± 0.22

Median (min, max)

0.87 (0.48, 1.72)

Hemoglobin (g/dL)

Mean ± SD

15.01 ± 1.67

Median (min, max)

15.00 (10.50, 20.80)

High-sensitivity cardiac troponin (pg/mL)

Mean ± SD

7,244.84 ± 5,852.58

Median (min, max)

5,695.00 (38, 32,287)

Left ventricular ejection fraction by CMR (%)

Mean ± SD

48.25 ± 11.24

Median (min, max)

48.00 (19.10, 71.90)

**Table 2.** Absolute and Relative Frequencies of Pain Site and Irradiation of Patients Evaluated in the Study
Viriables	N (%)
Localization
Precordial	85 (38.1)
Retrosternal	90 (40.4)
Right upper limb	2 (0.9)
Both upper limbs	3 (1.3)
Left upper limb	15 (6.7)
Epigastric	22 (9.9)
Neck/mandible	6 (2.7)
Irradiation
Without irradiation	79 (35.4)
Right upper limb	7 (3.1)
Both upper limbs	21 (9.4)
Right upper limb and neck/mandible	1 (0.4)
Right upper limb and retrosternal	1 (0.4)
Both upper limbs and neck/mandible	2 (0.9)
Left upper limb	62 (27.8)
Left upper limb and neck/mandible	12 (5.4)
Left upper limb and epigastric	1 (0.4)
Left upper limb and precordial	1 (0.4)
Left upper limb and retrosternal	1 (0.4)
Left upper limb, epigastric and precordial	1 (0.4)
Neck/mandible	7 (3.1)
Neck/mandible and precordial	2 (0.9)
Neck/mandible and retrosternal	1 (0.4)
Epigastric	7 (3.1)
Precordial	11 (4.9)
Retrosternal	6 (2.7)

Table 2. Absolute and Relative Frequencies of Pain Site and Irradiation of Patients Evaluated in the Study

Viriables

N (%)

Localization

Precordial

85 (38.1)

Retrosternal

90 (40.4)

Right upper limb

2 (0.9)

Both upper limbs

3 (1.3)

Left upper limb

15 (6.7)

Epigastric

22 (9.9)

Neck/mandible

6 (2.7)

Irradiation

Without irradiation

79 (35.4)

Right upper limb

7 (3.1)

Both upper limbs

21 (9.4)

Right upper limb and neck/mandible

1 (0.4)

Right upper limb and retrosternal

1 (0.4)

Both upper limbs and neck/mandible

2 (0.9)

Left upper limb

62 (27.8)

Left upper limb and neck/mandible

12 (5.4)

Left upper limb and epigastric

1 (0.4)

Left upper limb and precordial

1 (0.4)

Left upper limb and retrosternal

1 (0.4)

Left upper limb, epigastric and precordial

1 (0.4)

Neck/mandible

7 (3.1)

Neck/mandible and precordial

2 (0.9)

Neck/mandible and retrosternal

1 (0.4)

Epigastric

7 (3.1)

Precordial

11 (4.9)

Retrosternal

6 (2.7)

**Table 3.** Absolute and Relative Frequencies of Pain Sites According to the Culprit Arteries
Localization	Artery
Likelihood ratio Chi-square test: P = 0.237. RCA: right coronary artery; LCX: left circumflex; LAD: left anterior descending.
Precordial	40 (45.5)	11 (44.0)	34 (30.9)
Retrosternal	31 (35.2)	9 (36.0)	50 (45.5)
Right upper limb	1 (1.1)	1 (4.0)	0 (0.0)
Both upper limbs	0 (0.0)	0 (0.0)	3 (2.7)
Left upper limb	4 (4.5)	2 (8.0)	9 (8.2)
Epigastric	9 (10.2)	1 (4.0)	12 (10.9)
Neck/mandible	3 (3.4)	1 (4.0)	2 (1.8)

Table 3. Absolute and Relative Frequencies of Pain Sites According to the Culprit Arteries

Localization

Artery

RCA (n = 88)

LCX (n = 25)

LAD (n = 110)

N (%)

Likelihood ratio Chi-square test: P = 0.237. RCA: right coronary artery; LCX: left circumflex; LAD: left anterior descending.

Precordial

40 (45.5)

11 (44.0)

34 (30.9)

Retrosternal

31 (35.2)

9 (36.0)

50 (45.5)

Right upper limb

1 (1.1)

1 (4.0)

0 (0.0)

Both upper limbs

0 (0.0)

3 (2.7)

Left upper limb

4 (4.5)

2 (8.0)

9 (8.2)

Epigastric

9 (10.2)

1 (4.0)

12 (10.9)

Neck/mandible

3 (3.4)

1 (4.0)

2 (1.8)

**Table 4.** Distribution of Arterial Territories According to Pain Irradiation
Irradiation	Artery
Likelihood ratio Chi-square test: P = 0.473. RCA: right coronary artery; LCX: left circumflex; LAD: left anterior descending.
Without irradiation	32 (36.4)	12 (48.0)	35 (31.8)
Right upper limb	4 (4.5)	0 (0.0)	3 (2.7)
Both upper limbs	7 (8.0)	4 (16.0)	10 (9.1)
Right upper limb and neck/mandible	0 (0.0)	1 (4.0)	0 (0.0)
Right upper limb and retrosternal	0 (0.0)	0 (0.0)	1 (0.9)
Both upper limbs and neck/mandible	1 (1.1)	0 (0.0)	1 (0.9)
Left upper limb	25 (28.4)	4 (16.0)	33 (30.0)
Left upper limb and neck/mandible	5 (5.7)	0 (0.0)	7 (6.4)
Left upper limb and epigastric	0 (0.0)	0 (0.0)	1 (0.9)
Left upper limb and precordial	1 (1.1)	0 (0.0)	0 (0.0)
Left upper limb and retrosternal	0 (0.0)	1 (4.0)	0 (0.0)
Left upper limb, epigastric and precordial	1 (1.1)	0 (0.0)	0 (0.0)
Neck/mandible	3 (3.4)	1 (4.0)	3 (2.7)
Neck/mandible and precordial	1 (1.1)	0 (0.0)	1 (0.9)
Neck/mandible and retrosternal	0 (0.0)	0 (0.0)	1 (0.9)
Epigastric	4 (4.5)	1 (4.0)	2 (1.8)
Precordial	3 (3.4)	0 (0.0)	8 (7.3)
Retrosternal	1 (1.1)	1 (4.0)	4 (3.6)

Table 4. Distribution of Arterial Territories According to Pain Irradiation

Irradiation

Artery

RCA (n = 88)

LCX (n = 25)

LAD (n = 110)

N (%)

Likelihood ratio Chi-square test: P = 0.473. RCA: right coronary artery; LCX: left circumflex; LAD: left anterior descending.

Without irradiation

32 (36.4)

12 (48.0)

35 (31.8)

Right upper limb

4 (4.5)

0 (0.0)

3 (2.7)

Both upper limbs

7 (8.0)

4 (16.0)

10 (9.1)

Right upper limb and neck/mandible

0 (0.0)

1 (4.0)

0 (0.0)

Right upper limb and retrosternal

0 (0.0)

1 (0.9)

Both upper limbs and neck/mandible

1 (1.1)

0 (0.0)

1 (0.9)

Left upper limb

25 (28.4)

4 (16.0)

33 (30.0)

Left upper limb and neck/mandible

5 (5.7)

0 (0.0)

7 (6.4)

Left upper limb and epigastric

0 (0.0)

1 (0.9)

Left upper limb and precordial

1 (1.1)

0 (0.0)

Left upper limb and retrosternal

0 (0.0)

1 (4.0)

0 (0.0)

Left upper limb, epigastric and precordial

1 (1.1)

0 (0.0)

Neck/mandible

3 (3.4)

1 (4.0)

3 (2.7)

Neck/mandible and precordial

1 (1.1)

0 (0.0)

1 (0.9)

Neck/mandible and retrosternal

0 (0.0)

1 (0.9)

Epigastric

4 (4.5)

1 (4.0)

2 (1.8)

Precordial

3 (3.4)

0 (0.0)

8 (7.3)

Retrosternal

1 (1.1)

1 (4.0)

4 (3.6)

**Table 5.** Absolute and Relative Frequencies of Fibrotic Segments According to Pain Sites and Axis Evaluated on Cardiac Magnetic Resonance
Local	Precordial	Retrosternal	Right upper limb	Both upper limbs	Left upper limb	Epigastric	Neck/mandible	P*
*Descriptive level of probability of Fisher’s exact test.
Basal short axis
Anterior, n (%)	5 (5.9)	6 (6.7)	0 (0.0)	0 (0.0)	2 (13.3)	2 (9.1)	1 (16.7)	0.616
Anteroseptal, n (%)	9 (10.6)	14 (15.6)	0 (0.0)	0 (0.0)	1 (6.7)	2 (9.1)	0 (0.0)	0.902
Inferoseptal, n (%)	24 (28.2)	10 (11.1)	0 (0.0)	0 (0.0)	2 (13.3)	5 (22.7)	2 (33.3)	0.083
Inferior, n (%)	37 (43.5)	26 (28.9)	1 (50.0)	0 (0.0)	3 (20.0)	6 (27.3)	2 (33.3)	0.230
Inferolateral, n (%)	22 (25.9)	19 (21.1)	1 (50.0)	0 (0.0)	2 (13.3)	3 (13.6)	3 (50.0)	0.346
Anterolateral, n (%)	3 (3.5)	6 (6.7)	1 (50.0)	0 (0.0)	1 (6.7)	2 (9.1)	0 (0.0)	0.264
Mid short axis
Anterior, n (%)	26 (30.6)	34 (37.8)	0 (0.0)	0 (0.0)	7 (46.7)	9 (40.9)	0 (0.0)	0.266
Anteroseptal, n (%)	29 (34.1)	35 (38.9)	0 (0.0)	1 (33.3)	8 (53.3)	10 (45.5)	1 (16.7)	0.605
Inferoseptal, n (%)	28 (32.9)	17 (18.9)	0 (0.0)	0 (0.0)	3 (20.0)	5 (22.7)	2 (33.3)	0.380
Inferior, n (%)	41 (48.2)	31 (34.4)	1 (50.0)	0 (0.0)	1 (6.7)	6 (27.3)	3 (50.0)	0.015
Inferolateral, n (%)	24 (28.2)	20 (22.2)	1 (50.0)	1 (33.3)	4 (26.7)	5 (22.7)	3 (50.0)	0.608
Anterolateral, n (%)	14 (16.5)	12 (13.3)	1 (50.0)	0 (0.0)	2 (13.3)	3 (13.6)	1 (16.7)	0.771
Apical short axis
Anterior, n (%)	31 (36.5)	40 (44.4)	0 (0.0)	1 (33.3)	8 (53.3)	11 (50.0)	2 (33.3)	0.680
Septal, n (%)	36 (42.4)	41 (45.6)	0 (0.0)	0 (0.0)	8 (53.3)	13 (59.1)	2 (33.3)	0.404
Inferior, n (%)	46 (54.1)	29 (32.2)	1 (50.0)	2 (66.7)	5 (33.3)	12 (54.5)	3 (50)	0.051
Lateral, n (%)	26 (30.6)	25 (27.8)	1 (50.0)	2 (66.7)	5 (33.3)	6 (27.3)	2 (33.3)	0.785
Long axis
Apex, n (%)	19 (22.4)	19 (21.1)	0 (0.0)	0 (0.0)	6 (40.0)	9 (40.9)	2 (33.3)	0.271

Table 5. Absolute and Relative Frequencies of Fibrotic Segments According to Pain Sites and Axis Evaluated on Cardiac Magnetic Resonance

Local

Precordial

Retrosternal

Right upper limb

Both upper limbs

Left upper limb

Epigastric

Neck/mandible

*Descriptive level of probability of Fisher’s exact test.

Basal short axis

Anterior, n (%)

5 (5.9)

6 (6.7)

0 (0.0)

2 (13.3)

2 (9.1)

1 (16.7)

0.616

Anteroseptal, n (%)

9 (10.6)

14 (15.6)

0 (0.0)

1 (6.7)

2 (9.1)

0 (0.0)

0.902

Inferoseptal, n (%)

24 (28.2)

10 (11.1)

0 (0.0)

2 (13.3)

5 (22.7)

2 (33.3)

0.083

Inferior, n (%)

37 (43.5)

26 (28.9)

1 (50.0)

0 (0.0)

3 (20.0)

6 (27.3)

2 (33.3)

0.230

Inferolateral, n (%)

22 (25.9)

19 (21.1)

1 (50.0)

0 (0.0)

2 (13.3)

3 (13.6)

3 (50.0)

0.346

Anterolateral, n (%)

3 (3.5)

6 (6.7)

1 (50.0)

0 (0.0)

1 (6.7)

2 (9.1)

0 (0.0)

0.264

Mid short axis

Anterior, n (%)

26 (30.6)

34 (37.8)

0 (0.0)

7 (46.7)

9 (40.9)

0 (0.0)

0.266

Anteroseptal, n (%)

29 (34.1)

35 (38.9)

0 (0.0)

1 (33.3)

8 (53.3)

10 (45.5)

1 (16.7)

0.605

Inferoseptal, n (%)

28 (32.9)

17 (18.9)

0 (0.0)

3 (20.0)

5 (22.7)

2 (33.3)

0.380

Inferior, n (%)

41 (48.2)

31 (34.4)

1 (50.0)

0 (0.0)

1 (6.7)

6 (27.3)

3 (50.0)

0.015

Inferolateral, n (%)

24 (28.2)

20 (22.2)

1 (50.0)

1 (33.3)

4 (26.7)

5 (22.7)

3 (50.0)

0.608

Anterolateral, n (%)

14 (16.5)

12 (13.3)

1 (50.0)

0 (0.0)

2 (13.3)

3 (13.6)

1 (16.7)

0.771

Apical short axis

Anterior, n (%)

31 (36.5)

40 (44.4)

0 (0.0)

1 (33.3)

8 (53.3)

11 (50.0)

2 (33.3)

0.680

Septal, n (%)

36 (42.4)

41 (45.6)

0 (0.0)

8 (53.3)

13 (59.1)

2 (33.3)

0.404

Inferior, n (%)

46 (54.1)

29 (32.2)

1 (50.0)

2 (66.7)

5 (33.3)

12 (54.5)

3 (50)

0.051

Lateral, n (%)

26 (30.6)

25 (27.8)

1 (50.0)

2 (66.7)

5 (33.3)

6 (27.3)

2 (33.3)

0.785

Long axis

Apex, n (%)

19 (22.4)

19 (21.1)

0 (0.0)

6 (40.0)

9 (40.9)

2 (33.3)

0.271