Aim Ischaemic heart diseases including acute myocardial infarction (MI) are regarded as one of the causes of chest pain. The study aimed to investigate the diagnostic pattern and aetiology of prehospital patients, either presenting with chest pain as main symptom or receiving MI as diagnosis at discharge.

Method The study was a retrospective, register-based cohort study describing prehospital patients either presenting with chest pain or diagnosed with MI in the North Denmark Region. Patients were included if they were transferred to a hospital in the region after prior contact with emergency medical services during 2011–2014.

Results Out of a total 71 870 prehospital patients, there were 10 679 patients with chest pain (14.9% of all). The diagnoses were diseases of the circulatory system (35.3%, 9.6% with MI), the respiratory system (5.2%), the digestive system (3.8%), and ‘nonspecific diagnoses’ (46.1%). 1365 patients (1.9% of all prehospital patients) were diagnosed with MI. These mainly presented with chest pain (75.0%), unclear problems (9.1%), and difficulty in breathing (7.3%). When comparing MI-patients presenting with chest pain and patients without chest pain (1,024 vs 341 patients), more were men (71.8% vs 59.9%), had lower mortality (4.9% vs 27.7%), and a comorbidity score of 0 (64.0% vs 44.3%). The sensitivity of chest pain as test for MI was 75.0% and the specificity was 86.3%.

Conclusion The majority of patients with chest pain had other diagnoses than circulatory diseases, and 90.4% did not have MI. However, most MI-patients presented with chest pain and these had better outcomes than the ones without chest pain.

Conflict of interest None

Funding The professorship of EFC is supported by a grant administered by Aalborg University from the Danish philanthropic foundation TrygFonden. The foundation had no influence on the research.