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J Am Heart Assoc. 2018 Mar 10;7(6). pii: e007297. doi: 10.1161/JAHA.117.007297.

Relations of Sex to Diagnosis and Outcomes in Acute Coronary Syndrome.

Author information

1
Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany.
2
German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
3
Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
4
German Center for Cardiovascular Research, Partner Site RheinMain, Hamburg, Germany.
5
Department of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.
6
Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.
7
Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany r.schnabel@uke.de.

Abstract

BACKGROUND:

The atypical presentation of women with acute coronary syndrome (ACS) has been related to delayed diagnosis and treatment, which may explain worse outcome compared with men.

METHODS AND RESULTS:

We analyzed pooled data of 2520 patients of 2 prospective cohorts in terms of differences in presentation and management of women and men suggestive of ACS. Using logistic regression, we established 2 diagnostic models and tested their diagnostic performance in both sexes separately. Sex-specific differences in management of patients with ACS were ascertained and a 2-year follow-up was performed. Women were older than men (median 67 versus 61 years, P=0.001), had more often dyspnea (22% versus 18%, P=0.024), nausea or vomiting (26% versus 16%, P=0.001) and radiating chest pain (47% versus 40%, P=0.001). Classical risk factors (smoking, diabetes mellitus, dyslipidemia or known coronary artery disease) were less frequent in women. Diagnostic models showed no significant sex-related differences in diagnostic performance in a "first contact" setting (medical history and symptoms) or after "complete triage" (including ECG and biomarkers). Women with ACS underwent coronary angiography (73.8% versus 84.3%, P<0.001) and revascularization (53.8% versus 70.1%, P<0.001) less frequently. Two-year incidence of myocardial infarction and death was similar in both sexes, but revascularization and cardiac rehospitalization were more frequent in men.

CONCLUSIONS:

In a large cohort of patients with suspected ACS, sex differences in clinical presentation did not impair diagnostic accuracy. Two-year outcomes were comparable. Our findings suggest a benefit of chest pain units to minimize sex differences in ACS management and prognosis.

CLINICAL TRIAL REGISTRATION:

URL: https://www.clinicaltrials.gov. Unique identifiers: NCT02355457 (BACC), NCT03227159 (stenoCardia).

KEYWORDS:

diagnosis; outcome; sex‐specific; troponin

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