Results:

The median age for both sexes was 49 years. More than one half of women enrolled in the study were premenopausal or perimenopausal, and 40% were obese. Women were more likely than men to have hypertension, diabetes, and depression. Women were more likely to have non–ST-segment elevation myocardial infarction (37.5 vs. 30.7; p = 0.03) and present without chest pain compared with men (19.0% vs. 13.7%; p = 0.03). Among those who underwent coronary angiography, men were more likely to have >50% coronary stenosis in at least one vessel than women. There was no significant sex difference in prevalence of triple-vessel disease or presence of left main disease. Patients without chest pain reported fewer symptoms overall, and no discernable pattern of non–chest pain symptoms was found. In the multivariate model, being a woman (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.23-3.11; p = 0.005) and tachycardia (OR, 2.07; 95% CI, 1.20-3.56; p = 0.009) were independently associated with ACS presentation without chest pain. Patients without chest pain did not differ significantly from those with chest pain in terms of ACS type, troponin level elevation, or coronary stenosis.