Typical Symptoms Are Predictive of Acute Coronary Syndromes in Women


Am Heart J. 2002;143(2) 

In This Article

Abstract and Introduction

Background. Previous research suggests that the presentation of acute coronary syndromes (ACS) may differ in women and men. No study has prospectively evaluated the role of a comprehensive set of typical and atypical symptoms and whether different symptoms on presentation predict ACS diagnosis in women and men.
Methods. and Results We directly observed 246 women and 276 men seen in the emergency department with symptoms suggestive of ACS and documented their symptoms verbatim. ACS was eventually diagnosed in 89 (36%) women and 124 (45%) men on the basis of standard electrocardiogram and cardiac enzyme criteria. Presence of typical symptoms (chest pain or discomfort, dyspnea, diaphoresis, and arm or shoulder pain) was significantly associated with a diagnosis of ACS in women but not in men. On the other hand, atypical symptoms were not related to ACS diagnosis in women, whereas in men some atypical symptoms (dizziness or faintness) were inversely associated with ACS (P = .007). In multivariate analysis, the only symptoms that showed significant or borderline associations with ACS in women were diaphoresis (P = .019) and chest pain or discomfort (P = .069). Chest pain or discomfort and other typical symptoms were not significantly associated with ACS in men. Adjusted relative risks for ACS associated with the presence of typical symptoms in women compared with men were close to 1.0, indicating no sex differences.
Conclusions. Typical symptoms are the strongest symptom predictors of ACS in women, and they are as important in women as in men. Clinicians need to take very seriously any woman who has typical symptoms and pursue a full cardiac work-up.

Our knowledge of symptoms associated with acute coronary syndromes (ACS) is derived primarily from male samples. Acute ischemia is more likely to be missed in the emergency department (ED) in women than it is in men,[1] perhaps as a result of differences in symptom presentation. A number of studies have compared the symptom presentation of women and men with ACS.[2,3,4,5,6,7,8,9,10] In most of these studies, the prevalence of chest pain was similar in women and men. However, women were more likely to have atypical symptoms compared with men.[3,6,7,8,9]

By comparing the symptom prevalence in women and men with ACS, most of these studies have not addressed the issue of whether symptoms are associated with ACS differently in women and men. For example, a greater prevalence of atypical symptoms in women with ACS compared with men may simply reflect the fact that these atypical symptoms are generally more common in women, even in the absence of diagnosed ACS.

The purpose of this study was to evaluate, in a prospective fashion, the role of a comprehensive set of typical and atypical symptoms on presentation as predictors of ACS in women and men. We hypothesized that although chest pain or discomfort and other typical symptoms predict ACS both in women and men, atypical symptoms would predict ACS in women but not in men.


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