Results:

Of the 1,174 eligible patients who were approached for study enrollment, 10% of women and 18% of men declined participation in the study, resulting in a final participation rate of 86% (n = 1,015). The median age of women and men was 49 years, 40% were obese, and more than half of women enrolled in the study were premenopausal or perimenopausal. 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). 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. Of all patients in the ACS cohort, 96.6% of men and 97.0% of women reported at least one symptom: either chest pain, shortness of breath, or one of the non–chest pain symptoms included in the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey. Women were more likely to present without chest pain compared with men (19.0% vs. 13.7%; p = 0.03). 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%CI, 1.23-3.11]; P = .005) and tachycardia (OR, 2.07 [95%CI, 1.20-3.56]; P = .009) were independently associated with ACS presentation without chest pain. The most common non–chest pain symptoms in both sexes regardless of ACS type were weakness, feeling hot, shortness of breath, cold sweats, and pain in the left arm or shoulder. Patients without chest pain did not differ significantly from those with chest pain in terms of ACS type, troponin level elevation, or coronary stenosis.