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 |
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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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