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Original Investigation |

Sex Differences in Acute Coronary Syndrome Symptom Presentation in Young Patients

Nadia A. Khan, MD, MSc1; Stella S. Daskalopoulou, MD, PhD2,6; Igor Karp, MD, PhD3; Mark J. Eisenberg, MD, MPH4; Roxanne Pelletier, PhD2,7; Meytal Avgil Tsadok, PhD2,7; Kaberi Dasgupta, MD, MSc2,6,7; Colleen M. Norris, PhD5 ; Louise Pilote, MD, MPH, PhD2,6,7 ; for the GENESIS PRAXY Team
[+] Author Affiliations
1Department of Medicine, Center for Health Evaluation and Outcomes Science, University of British Columbia, Vancouver, British Columbia, Canada
2Research Institute of the McGill University Health Center, Montreal, Québec, Canada
3University of Montréal Hospital Research Center and Department of Social and Preventive Medicine, University of Montréal, Montréal, Québec, Canada
4Divisions of Cardiology and of Clinical Epidemiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada
5 Faculties of Nursing and Medicine and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
6Division of General Internal Medicine, McGill University Health Center, Montréal, Québec, Canada
7Division of Clinical Epidemiology, McGill University Health Center, Montréal, Québec, Canada
JAMA Intern Med. 2013;173(20):1863-1871. doi:10.1001/jamainternmed.2013.10149.
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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.

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Figure.
Symptoms at Presentation for Acute Coronary Syndrome by Sex and Presence and Absence of Chest Pain

A, Men with acute coronary syndrome; B, women with acute coronary syndrome.

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