Presenting Symptoms in Men and Women Diagnosed With Myocardial Infarction Using Sex‐Specific Criteria

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Fiona E. Strachan¹  Andrew R. Chapman¹  Katherine Orme¹  Atul Anand¹  Stacey D. Stewart¹  Simon Jones¹  Anoop S. V. Shah¹  Nicholas L. Mills¹  Kuan Ken Lee¹  Amy V. Ferry¹  Lucy Marshall¹  Leanne Mooney² 

[1] BHF Centre for Cardiovascular Science University of Edinburgh United Kingdom;Royal Victoria Hospital Kirkcaldy United Kingdom;

关键词: acute coronary syndrome;    chest pain;    chest pain diagnosis;    myocardial infarction;    sex;   

DOI  :  10.1161/JAHA.119.012307

来源: DOAJ

【 摘 要 】

Background Sex‐specific criteria are recommended for the diagnosis of myocardial infarction, but the impact of these on presenting characteristics is unknown. Methods and Results We evaluated patient‐reported symptoms in 1941 patients (39% women) with suspected acute coronary syndrome attending the emergency department in a substudy of a prospective trial. Standardized criteria defined typical and atypical presentations based on pain nature, location, radiation, and additional symptoms. Diagnosis of myocardial infarction was adjudicated using a high‐sensitivity cardiac troponin I assay with sex‐specific thresholds (>16 ng/L women, >34 ng/L men). Patients identified who were missed by the contemporary assay with a uniform threshold (≥50 ng/L) were reclassified by this approach. Type 1 myocardial infarction was diagnosed in 16% (184/1185) of men and 12% (90/756) of women, with 9 (5%) men and 27 (30%) women reclassified using high‐sensitivity cardiac troponin I and sex‐specific thresholds. Chest pain was the presenting symptom in 91% (1081/1185) of men and 92% (698/756) of women. Typical symptoms were more common in women than in men with myocardial infarction (77% [69/90] versus 59% [109/184]; P=0.007), and differences were similar in those reclassified (74% [20/27] versus 44% [4/9]; P=0.22). The presence of ≥3 typical features was associated with a positive likelihood ratio for the diagnosis of myocardial infarction in women (positive likelihood ratio, 1.18; 95% CI, 1.03–1.31) but not in men (positive likelihood ratio 1.09; 95% CI, 0.96–1.24). Conclusions Typical symptoms are more common and have greater predictive value in women than in men with myocardial infarction whether or not they are diagnosed using sex‐specific criteria. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier NCT01852123.

【 授权许可】

Unknown