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DearReviewers,Thankyouforyourthoughtful,helpful,andmostkindreviewofmanuscript2006/036.Yourcommentsandsuggestionshavebeenincorporatedasappropriateintothereviseddraft.Specificrevisionsarenotedbelow.ReviewerCommentAuthors’ResponseReviewer#1Moredetailonthemethodofinterviewingparticipantsshouldbeadded.Table1hasbeenaddedthatspecificallynotesmethodsofdatacollection,instrumentsusedifapplicableandanyspecialinformationrelatedtotimingofinterviews.AdditionofalegendforTable3(nowTable4)wouldbehelpful.Thishasbeenadded.Elaborationoftheimplicationsofthestudyforhealthcareprovidersandpatients.Moreimplicationshavebeenadded;however,thisisearlyresearch,andthefullextentoftheimplicationsisnotcompletelyknownatthistime.Additionofmorespecificdirectionsforfutureresearch.Thesehavebeenaddedintheconclusionssection,Reviewer#2Makeanexplicitstatementthattheapproachissomewhatatheoreticalanddatadriven.Thishasbeenaddedunderdataanalysis,aswellasintheabstract.PotentialproblemofimplyingthatclustersmayenhanceidentificationofAMIforthelaypublicandprofessionalsrelatedtofactthatonlypersonswithdiagnosedAMIwerestudied.WeagreethatallpresentationsforAMImaynotberepresentedinthisstudy.Wehavenotedthatasalimitation.Assessingthesymptomsofpersonswhohavenotbeendiagnosed,however,wouldbeverychallengingifnotimpossible.Hopefully,onceweidentifysomeoftheclusters,theywillleadustopresentationsofpersonswhodonotgetdiagnosedforavarietyofdifferentreasons.Theresultsofthisstudymustbeconsideredprovisionalhypothesisandinneedofsubsequentsupportinindependentandideallyprospectivesamples.Weagreeandplantodothis.Wehavenotedthatmorestudyleadingtovalidationofthesefindingsisneeded.Someofthedataanalysiscouldbepresentedmoreclearly.Wehopethatthisrevisionpresentsthestepsindataanalysismoreclearly.Methodologicallimitations:1.Moreaboutsourcestudies.Table2hasbeenaddedwithmoredetailedinformationonthesourcestudies.Thisincludesyearofpublication(ifapplicable),inclusioncriteria,etc.Inaddition,astatementwasaddedinthetextstatingthatalldatawerecollectedafter1990.MoststudiesusedECGandserummarkersforsubjectidentification,andthisisindicated.SubjectswithNSTEMIwereincluded.Allsourcestudiesthathavebeenpublishedareincludedinthereferencelist.2.Questionsonallsymptomsinallstudies.Notallsymptomswereassessedinallstudies.Thisisalimitationofsecondarydataanalysis.ThespecificnumberofpersonsassessedforeachsymptomisnotedinTable3,andthisisnotedinthetext.3.ReordersymptomsinTable2inorderofoccurrence.Thishasbeendone.4.Weakjustificationforchoosing5ratherthan6clusters.Thishasbeenaddressedinthetext.ThankyouforpointingouttheLokenreference.WeagreethattheBICisaconservativeapproachtoassessingmodelfitandhavenotedthisinthemanuscript.However,Lokenalsostatesthatthebestmethodforassessingfitremainscontroversial.Therefore,weusedallofthestatisticsavailableandrelatedthemtoformourconclusion.Wehopethatwehavestatedthispointclearly.5.FootnotingofabbreviationsinTable3(nowTable4)andmoreexplanatorycaption.Thishasbeenadded,thankyouforthesuggestion.Addatablesummarizingsymptomsforeachcluster.Thankyouforthisexcellentsuggestion.Table6hasbeenadded.StrengthsandLimitations1.Statementrelatedtogeneralizabilityoffindings.Thisstatementhasbeenremoved.2.LimitationrelatedtosampleonlyconsistingofcasesofconfirmedAMI.Astatementhasbeenaddedrelatedtothislimitation.Alsotheinclusioncriteria(troponin/CK-MB)forthesourcestudieshavebeenaddedinTable6.StudybyRyanandZerwicinbackground.ThisstudyassessedperceptionsofAMIsymptoms,notactualAMIsymptomsthatwereexperienced.Thepointofthestudywastoexaminewhetherpersonswereabletoidentifysymptomclusters.Wedidnotaddmoredetailsoftheresultsofthisstudybecausewedonotthinkthattheyreallycomparetothepresentanalysis.Editorialsuggestions.Thesehavebeencorrected.Thankyouforpickingthemup.Thankyouagainforyourkindandthoughtfulcomments.Wehopethattherevisionaddressesyourconcerns.