IMPORTANCE: Little is known about whether sex differences in acute coronary syndrome (ACS) presentation exist in young patients and what factors determine absence of chest pain in ACS presentation. OBJECTIVES: To evaluate sex differences in ACS presentation and to estimate associations between sex, sociodemographic, gender identity, psychosocial and clinical factors, markers of coronary disease severity, and absence of chest pain in young patients with ACS. DESIGN, SETTING, PARTICIPANTS: We conducted a prospective cohort study of 1015 patients (30% women) 55 years or younger, hospitalized for ACS and enrolled in the GENESIS PRAXY (Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome) study (January 2009-September 2012). MAIN OUTCOMES AND MEASURES: The McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey was administered during hospitalization. RESULTS: The median age for both sexes was 49 years. Women were more likely to have non-ST-segment elevation myocardial infarction (37.5 vs 30.7; P = .03) and present without chest pain compared with men (19.0% vs 13.7%; P = .03). Patients without chest pain reported fewer symptoms overall and no discernable pattern of non-chest pain symptoms was found. In the multivariate model, being a woman (odds ratio [OR], 1.95 [95% CI, 1.23-3.11]; P = .005) and tachycardia (OR, 2.07 [95% CI, 1.20-3.56]; P = .009) were independently associated with ACS presentation without chest pain. Patients without chest pain did not differ significantly from those with chest pain in terms of ACS type, troponin level elevation, or coronary stenosis. CONCLUSIONS AND RELEVANCE: Chest pain was the most common ACS symptom in both sexes. Although women were more likely to present without chest pain than men, absence of chest pain was not associated with markers of coronary disease severity. Strategies that explicitly incorporate assessment of common non-chest pain symptoms need to be evaluated.
IMPORTANCE: Little is known about whether sex differences in acute coronary syndrome (ACS) presentation exist in young patients and what factors determine absence of chest pain in ACS presentation. OBJECTIVES: To evaluate sex differences in ACS presentation and to estimate associations between sex, sociodemographic, gender identity, psychosocial and clinical factors, markers of coronary disease severity, and absence of chest pain in young patients with ACS. DESIGN, SETTING, PARTICIPANTS: We conducted a prospective cohort study of 1015 patients (30% women) 55 years or younger, hospitalized for ACS and enrolled in the GENESIS PRAXY (Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome) study (January 2009-September 2012). MAIN OUTCOMES AND MEASURES: The McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey was administered during hospitalization. RESULTS: The median age for both sexes was 49 years. Women were more likely to have non-ST-segment elevation myocardial infarction (37.5 vs 30.7; P = .03) and present without chest pain compared with men (19.0% vs 13.7%; P = .03). Patients without chest pain reported fewer symptoms overall and no discernable pattern of non-chest pain symptoms was found. In the multivariate model, being a woman (odds ratio [OR], 1.95 [95% CI, 1.23-3.11]; P = .005) and tachycardia (OR, 2.07 [95% CI, 1.20-3.56]; P = .009) were independently associated with ACS presentation without chest pain. Patients without chest pain did not differ significantly from those with chest pain in terms of ACS type, troponin level elevation, or coronary stenosis. CONCLUSIONS AND RELEVANCE: Chest pain was the most common ACS symptom in both sexes. Although women were more likely to present without chest pain than men, absence of chest pain was not associated with markers of coronary disease severity. Strategies that explicitly incorporate assessment of common non-chest pain symptoms need to be evaluated.
Authors: Petra Hillinger; Raphael Twerenbold; Karin Wildi; Maria Rubini Gimenez; Cedric Jaeger; Jasper Boeddinghaus; Thomas Nestelberger; Karin Grimm; Tobias Reichlin; Fabio Stallone; Christian Puelacher; Zaid Sabti; Nikola Kozhuharov; Ursina Honegger; Paola Ballarino; Oscar Miro; Kris Denhaerynck; Temizel Ekrem; Claudia Kohler; Roland Bingisser; Stefan Osswald; Christian Mueller Journal: Clin Res Cardiol Date: 2016-07-12 Impact factor: 5.460
Authors: Jean C McSweeney; Anne G Rosenfeld; Willie M Abel; Lynne T Braun; Lora E Burke; Stacie L Daugherty; Gerald F Fletcher; Martha Gulati; Laxmi S Mehta; Christina Pettey; Jane F Reckelhoff Journal: Circulation Date: 2016-02-29 Impact factor: 29.690
Authors: Emily M Bucholz; Kelly M Strait; Rachel P Dreyer; Stacy T Lindau; Gail D'Onofrio; Mary Geda; Erica S Spatz; John F Beltrame; Judith H Lichtman; Nancy P Lorenze; Hector Bueno; Harlan M Krumholz Journal: Eur Heart J Acute Cardiovasc Care Date: 2016-08-02
Authors: Mark Sweeney; Gillian Bleeze; Sarah Storey; Alexander Cairns; Alexander Taylor; Catherine Holmes; Steve Hart; Nick Lawrance; William G Oldfield; Christopher S Baker Journal: Future Healthc J Date: 2020-02