Presenting Symptoms in Men and Women Diagnosed With Myocardial Infarction Using Sex‐Specific Criteria. Issue 17 (September 2019)

• Record Type: Journal Article
• Authors: Ferry, Amy V.; Anand, Atul; Strachan, Fiona E.; Mooney, Leanne; Stewart, Stacey D.; Marshall, Lucy; Chapman, Andrew R.; Lee, Kuan Ken; Jones, Simon; Orme, Katherine; Shah, Anoop S. V.; Mills, Nicholas L.
• Is Part Of: Journal of the American Heart Association. Volume 8:Issue 17(2019)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2019-09
• Subjects: acute coronary syndrome -- chest pain -- chest pain diagnosis -- myocardial infarction -- sex; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cerebrovascular disease -- Periodicals; Cardiology -- Periodicals; 616.1
• DOI: 10.1161/JAHA.119.012307
• Languages: English
• ISSNs: 2047-9980

Abstract

Abstract : 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. Abstract : See Editorial Alraies and Piña