Sex-Specific Chest Pain Not Helpful in Early Diagnosis of AMI

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New data from a multinational study in Europe suggest that differences in chest pain experienced by men and women during acute MI (AMI) is not a helpful diagnostic tool. The study, published in the Journal of the American Medical Association Internal Medicine, supports earlier findings that there are statistically significant gender-related differences in the experience of chest pain in AMI, but likelihood ratios were so close to 1 that these differences are unlikely to be clinically helpful.

"Differences in sex-specific diagnostic performance of chest pain characteristics overall are small," said lead author Maria Rubini Gimenez, MD, University Hospital Basel, Switzerland. "Our findings do not seem to support the use of chest pain characteristics specific to women in the early diagnosis of AMI in women.

The Advantageous Predictors of Acute Coronary Syndrome Evaluation (APACE) study is an ongoing project conducted by centers in Switzerland, Spain and Italy. Researchers recruited 2,475 consecutive patients presenting to the emergency department with chest pain. Within the group, 143 women (18.0 percent) and 369 men (22.0 percent) were diagnosed with AMI. All patients were evaluated using a predetermined set of 34 chest pain characteristics (CPCs). Three of the 34 CPCs relating to pain duration and pain dynamics showed a statistically significant difference (p<0.05) between men and women. Because the likelihood ratios of the three CPCs were all close to 1 and the 95 percent confidence intervals were broad, the authors concluded that gender-related differences in chest pain are not likely to be clinically useful.

"The study revealed that none of the CPCs were more useful at enhancing the post-test probability of AMI in women compared with men," Lousie Pilote, MD, MPH, PhD, McGill University Health Center, Quebec, Canada, wrote in an accompanying editorial comment. "Their work clarifies that presentation of chest pain between men and women is not as different as commonly thought and provides new knowledge of the value and limitation of chest pain in making a diagnosis of AMI in women as well as in men."

Keywords: Acute Coronary Syndrome, Chest Pain, Early Diagnosis, Confidence Intervals, Probability

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