Background: Acute symptoms and their underlying cardiovascular risk factors are key components contributing to
the health care providers’ decisions to initiate medical treatment and further evaluation. Identification of
symptom and risk factor clusters is also needed to clarify prospective clinical outcomes in planning their treatment
strategies according to cluster type.
Purpose: This study was conducted to identify cluster subgroups considering both symptom and risk factor clusters
and examine the influence of cluster subgroups on the clinical outcome at 1 year after the acute event among first-
time acute myocardial infarction (AMI) patients.
Methods: Total of 263 ST-segment elevation myocardial infarction (STEMI) and 259 non-ST-segment elevation
myocardial infarction (NSTEMI) patients were interviewed individually from March 2008 to March 2010 at a
national university hospital. Medical records were also reviewed for major adverse cardiac events (MACEs) at the
1-year follow-up. Clustering of acute symptoms and risk factors were analyzed according to AMI type using Latent
Gold® software and the relationship between symptoms, risk factors and MACEs was analyzed by chi-square test
using SPSS program.
Results: Two clusters among 10 risk factors and 3 clusters among 15 symptoms were identified in both patients
with STEMI and NSTEMI. These two kinds of distinct clusters were significantly related to each other (p=.014).
The 6 cells extracted by the χ2 test were named cluster subgroups 1–6. There were significant differences in age,
gender, occupation, monthly income, and education according to the subgroups of STEMI and NSTEMI (p < .01).
MACEs during 1 year were significantly different by subgroups and mostly occurred in subgroup 6, characterized
by gastrointestinal symptom and hypertension/ diabetes dominant (p= .040).
Conclusion: Simultaneous assessment of symptoms and risk factors can be clinically useful for identification of
specific subgroups to educate treatment-seeking behavior and to need further intensive evaluation.
Key words: cardiovascular disease, risk factors, symptom clusters, acute myocardial infarction
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