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JAMA Intern Med. 2014 Feb 1;174(2):241-9. doi: 10.1001/jamainternmed.2013.12199.

Sex-specific chest pain characteristics in the early diagnosis of acute myocardial infarction.

Author information

1
Department of Cardiology, University Hospital Basel, Basel, Switzerland2Servicio de Urgencias y Pneumologia, Ciber de Enfermedades Raras, Carles III Institute for Health, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain.
2
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
3
Department of Cardiology, University Hospital Basel, Basel, Switzerland3Department of Cardiology, Universitäres Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany.
4
Department of Cardiology, University Hospital Basel, Basel, Switzerland4Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
5
Department of Cardiology, University Hospital Basel, Basel, Switzerland5Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
6
Department of Internal Medicine, Medizinische Klinik, Kantonsspital Olten, Olten, Switzerland.
7
Department of Internal Medicine, Notfallstation, Kantonsspital Liestal, Liestal, Switzerland.

Abstract

IMPORTANCE:

Whether sex-specific chest pain characteristics (CPCs) would allow physicians in the emergency department to differentiate women with acute myocardial infarction (AMI) from women with other causes of acute chest pain more accurately remains unknown. OBJECTIVE To improve the management of suspected AMI in women by exploring sex-specific CPCs.

DESIGN, SETTING, AND PARTICIPANTS:

From April 21, 2006, through August 12, 2012, we enrolled 2475 consecutive patients (796 women and 1679 men) presenting with acute chest pain to 9 emergency departments in a prospective multicenter study. The final diagnosis of AMI was adjudicated by 2 independent cardiologists.

INTERVENTIONS:

Treatment of AMI in the emergency department.

MAIN OUTCOMES AND MEASURES:

Sex-specific diagnostic performance of 34 predefined and uniformly recorded CPCs in the early diagnosis of AMI.

RESULTS:

Acute myocardial infarction was the adjudicated final diagnosis in 143 women (18.0%) and 369 men (22.0%). Although most CPCs were reported with similar frequency in women and men, several CPCs were reported more frequently in women (P < .05). The accuracy of most CPCs in the diagnosis of AMI was low in women and men, with likelihood ratios close to 1. Thirty-one of 34 CPCs (91.2%) showed similar likelihood ratios for the diagnosis of AMI in women and men, and only 3 CPCs (8.8%) seemed to have a sex-specific diagnostic performance with P < .05 for interaction. These CPCs 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 3 CPCs did not seem clinically helpful. Similar results were obtained when examining combinations of CPCs (all interactions, P ≥ .05).

CONCLUSIONS AND RELEVANCE:

Differences in the sex-specific diagnostic performance of CPCs are small and do not seem to support the use of women-specific CPCs in the early diagnosis of AMI. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00470587.

[Indexed for MEDLINE]

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