Based on the analyses of the likelihood ratios for AMI, the history is a helpful, but not diagnostic, first step in the assessment of patients with chest pain.
Specifically, no single factor in the history carries with it a consistently powerful enough likelihood ratio to enable the emergency physician to robustly diagnose ACS or exclude it. The history does, however, form a start point in the diagnostic process, broadly establishing whether pain is likely to be cardiac ischaemic (or not) in origin; it provides information to add to baseline cardiac risk factors [3], which makes the diagnosis of ACS significantly more or less likely.
Atypical presentations of ACS are common, occurring in up to 33% of patients, mostly in the elderly, diabetics and women. Advanced age, co-morbid factors, delay in diagnosis, delayed or reduced use of reperfusion therapy, and reduced use of adjuvant therapies all contribute to the increased mortality in this population.