Presenting symptoms in men and women diagnosed with myocardial infarction using sex‐specific criteria

Ferry, A. V. et al. (2019) Presenting symptoms in men and women diagnosed with myocardial infarction using sex‐specific criteria. Journal of the American Heart Association, 8(17), e012307. (doi: 10.1161/JAHA.119.012307) (PMID:31431112) (PMCID:PMC6755854)

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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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Mooney, Dr Leanne
Authors: Ferry, A. V., Anand, A., Strachan, F. E., Mooney, L., Stewart, S. D., Marshall, L., Chapman, A. R., Lee, K. K., Jones, S., Orme, K., Shah, A. S.V., and Mills, N. L.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Journal of the American Heart Association
Publisher:American Heart Association
ISSN:2047-9980
ISSN (Online):2047-9980
Published Online:20 August 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in Journal of the American Heart Association 8(17):e012307
Publisher Policy:Reproduced under a Creative Commons licence

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