Sex-Specific Chest Pain Characteristics in the Early Diagnosis of Acute Myocardial Infarction

Study Questions:

Do sex-specific chest pain characteristics allow physicians in the emergency department (ED) to differentiate women with acute myocardial infarction (AMI) from women with other causes of acute chest pain?

Methods:

Data for this study were collected as part of APACE (Advantageous Predictors of Acute Coronary Syndrome Evaluation), an ongoing prospective multicenter study (conducted in nine study sites in Switzerland, Spain, and Italy), from April 21, 2006, through August 12, 2012. The final diagnosis of AMI was adjudicated by two independent cardiologists.

Results:

A total of 2,475 consecutive patients (796 women and 1,679 men) presenting with acute chest pain were included in this analysis. AMI was the adjudicated final diagnosis in 143 women (18.0%) and 369 men (22.0%). Most chest pain characteristics were reported with similar frequency in women and men, and several characteristics were reported more frequently in women (p < 0.05). The accuracy of most chest pain characteristics in the diagnosis of AMI was low in women and men, with likelihood ratios close to 1. Thirty-one of thirty-four chest pain characteristics (91.2%) showed similar likelihood ratios for the diagnosis of AMI in women and men, and only three characteristics (8.8%) seemed to have a sex-specific diagnostic performance with p < 0.05 for interaction. These chest pain characteristics were related to pain duration (2-30 and >30 minutes) and dynamics (decreasing pain intensity). However, because their likelihood ratios were close to 1, the three characteristics did not seem clinically helpful.

Conclusions:

The investigators concluded that differences in the sex-specific diagnostic performance of chest pain characteristics are small and do not seem to support the use of women-specific characteristics in the early diagnosis of AMI.

Perspective:

These data suggest that sex-specific characteristics are not helpful in the diagnosis of AMI. Use of additional data including biomarkers, in addition to the patient’s symptoms, remains clinically important.

Clinical Topics: Acute Coronary Syndromes

Keywords: Men, Myocardial Infarction, Acute Coronary Syndrome, Women, Chest Pain, Spain, Switzerland, Italy


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