Typical Symptoms Are Predictive of Acute Coronary Syndromes in Women

Disclosures

Am Heart J. 2002;143(2) 

In This Article

Results

In the sample of 246 women, 89 (36%) were ultimately diagnosed with ACS. As expected, older women and women with a history of coronary heart disease, myocardial infarction, or diabetes were significantly more likely to be diagnosed with ACS compared with women without these risk factors (Table II). For example, 47% of women with diabetes versus 32% of women without diabetes were diagnosed with ACS for that ED visit. The mean age of women with ACS was 69 ± 15 years, and the mean age of women without ACS was 64 ± 15 years (P = .017). In contrast, other cardiac risk factors such as hypercholesterolemia, obesity, hypertension, and heart failure were not significantly associated with a diagnosis of ACS.

Women who had typical symptoms such as chest pain or discomfort, diaphoresis, dyspnea, and arm or shoulder pain were significantly more likely to be diagnosed with ACS compared with women who did not report these symptoms (Table III). For example, 41% of women with chest pain or discomfort versus 28% of women without chest pain or discomfort were diagnosed with ACS for that ED visit. In contrast, none of the atypical symptoms were related to ACS. Overall, women who were ultimately diagnosed with ACS reported a higher number of symptoms (3.36 ± 1.74 symptoms) compared with women without ACS (2.78 ± 1.46 symptoms, P = .006).

In the multivariate model with all the typical and atypical symptoms entered simultaneously, diaphoresis was the strongest independent positive predictor of ACS in women (Table IV). Women with chest pain or discomfort had an 81% higher risk for ACS, and women with arm or shoulder pain had a 60% higher risk for ACS. However, these latter symptoms did not reach statistical significance when included together in the model.

In the sample of 276 men, 124 (45%) were diagnosed with ACS for that ED visit. Older men were significantly more likely to be diagnosed with ACS, with a mean age of 64 ± 15 years versus a mean age of 58 ± 15 years for men without ACS (P = .005). Men with a history of other cardiac problems, such as valvular heart disease, primary arrhythmia, or nonischemic cardiomyopathy, were significantly less likely to be diagnosed with ACS than were men without this history (Table II).

Typical symptoms were not significantly related to a diagnosis with ACS in men (Table III). With regard to atypical symptoms, men who reported dizziness or faintness were significantly less likely to be diagnosed with ACS compared with men who did not report this symptom (Table III). There was no significant difference in the total number of symptoms between men with a diagnosis of ACS (2.55 ± 1.32 symptoms) and men without an ACS diagnosis (2.72 ± 1.40 symptoms).

In the model with all typical and atypical symptoms entered simultaneously, dizziness or faintness was an independent negative predictor of ACS in men (Table IV), whereas chest pain or discomfort and dyspnea were only mildly associated with a diagnosis of ACS in men. The fit of this model was poor (area under the ROC curve = 0.65, P = .06 for goodness-of-fit test), suggesting that symptoms were not helpful in predicting ACS in men.

The positive predictive values of presenting with typical symptoms were similar in women and men. For example, 41% of women and 49% of men who had chest pain or discomfort were subsequently diagnosed with ACS for that ED visit (Table III). In addition, we found that the adjusted relative risks for ACS in women with typical symptoms compared with men with typical symptoms were close to 1.0, indicating no sex differences (Table V).

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