Chest pain in women: clinical, investigative, and prognostic features

Sullivan, A K; Holdright, Diana R.; Wright, Christine; Sparrow, Jane; Cunningham, D. A.; Fox, Kim

doi:10.1136/bmj.308.6933.883

Cited by 235 publications

(135 citation statements)

References 21 publications

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“…Although confounding hypertension and diabetes, both of which affect the microvasculature, were more prevalent in women, previous cardiac or aortic surgery was more often documented in men (Table 1); diabetes and associated microvascular pathology are known to coincide with greater risk for cardiac mortality in women. 32 Increased mortality in type A dissection reminds us of the findings of increased mortality for women treated invasively with either percutaneous coronary intervention 33,34 or bypass surgery [35][36][37] for acute coronary syndromes.…”

Section: Nienaber Et Al Gender and Aortic Dissectionmentioning

confidence: 99%

Gender-Related Differences in Acute Aortic Dissection

et al. 2004

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Background-Few data exist on gender-related differences in clinical presentation, diagnostic findings, management, and outcomes in acute aortic dissection (AAD). Methods and Results-Accordingly, we evaluated 1078 patients enrolled in the International Registry of Acute Aortic Dissection (IRAD) to assess differences in clinical features, management, and in-hospital outcomes between men and women. Of the patients enrolled in IRAD (32.1%) with AAD, 346 were women. Although less frequently affected by AAD (32.1% of AAD), women were significantly older and had more often presented later than men (Pϭ0.008); symptoms of coma/altered mental status were more common, whereas pulse deficit was less common. Diagnostic imaging suggestive of rupture, ie, periaortic hematoma, and pleural or pericardial effusion were more commonly observed in women. In-hospital complications of hypotension and tamponade occurred with greater frequency in women, resulting in higher in-hospital mortality compared with men. After adjustment for age and hypertension, women with aortic dissection die more frequently than men (OR, 1.4, Pϭ0.04), predominantly in the 66-to 75-year age group. Moreover, surgical outcome was worse in women than men (Pϭ0.013); type A dissection in women was associated with a higher surgical mortality of 32% versus 22% in men despite similar delay, surgical technique, and hemodynamics. Conclusions-Our analysis provides insights into gender-related differences in AAD with regard to clinical characteristics, management, and outcomes; important diagnostic and therapeutic implications may help shed light on aortic dissection in women to improve their outcomes.

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Section: Nienaber Et Al Gender and Aortic Dissectionmentioning

confidence: 99%

Gender-Related Differences in Acute Aortic Dissection

et al. 2004

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“…Moreover, when women develop obstructive CAD they have a greater functional expression of their disease and disability compared with men. A majority of women without obstructive CAD at coronary angiography continue to have symptom-related disability and consume considerable healthcare resources, [15][16][17] in part because the pathophysiology of ischemia in women is incompletely understood and gender-specific diagnostic and treatment strategies are underdeveloped.…”

Section: Workhop Objectivesmentioning

confidence: 99%

Women’s Ischemic Syndrome Evaluation

Merz¹,

Bonow²,

Sopko³

et al. 2004

Circulation

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Endorsed by the American College of Cardiology Foundation T he WISE workshop was convened to review results from the Women's Ischemic Syndrome Evaluation (WISE) study and other studies of ischemic heart disease to examine the nature and scope of gender differences in both chronic and acute cardiac ischemia, in terms of clinical manifestations, detection, and treatment. The purpose of the workshop was to provide recommendations to National Heart, Lung and Blood Institute that (1) address the need for improved diagnosis of ischemia and coronary artery disease (CAD) in women; (2) explore strategies for improved translation of promising research results into clinical practice; and (3) assess opportunities for effective educational strategies, including further refinement of the key messages for women with regard to risk factors and heart attack symptoms. Workshop Objectives• To identify opportunities and needs in current state-of-theart knowledge in gender differences in manifestation and detection of ischemia and CAD in women.• To identify opportunities and provide recommendations on gender-based education for health professionals, patients, and the public.• To recommend future research directions in ischemia and CAD in women.CAD in women continues to be a major public health problem that represents a leading cause of death and disability. 1-3 Among US women, more than a quarter of a million deaths per year are attributed to CAD, and this figure is expected to increase in the first decades of the 21st century as our population ages. The increased prevalence of obesity and diabetes in women is also expected to contribute to this increase in CAD. Women have a higher frequency of angina/ chest pain than men; however, women have a lower prevalence of obstructive CAD compared with men with similar symptoms. 4 -6 Nevertheless, young women with obstructive CAD experience a significantly worse outcome compared with men with regard to prognosis after myocardial infarction, 7 and older women with obstructive CAD often have greater comorbidities that influence their outcome adversely after acute myocardial infarction or myocardial revascularization than do men. 8 -11 Women presenting with acute coronary syndromes (ACS) are also less likely to receive effective acute diagnostic and treatment strategies than men. [12][13][14] The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.

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“…To pokazuje i podatak da se aeene oboljele od KBS prosjeËno hospitaliziraju sa 68, dok se muπkarci hospitaliziraju sa 61 godinu aeivota. 8 Patoloπki koronarogram je pet puta ËeπÊi u muπkara-ca, ali u sluËaju njegove dijagnoze, muπkarci imaju bolje rezultate nakon postupka perkutane koronarne intervencije (PCI) [9][10][11][12] . VeÊ spomenuti veliki epidemioloπki znaËaj KBS, razlike u prevalenciji bolesti ovisno o spolu te potreba za definiranjem utjecaja razliËitih drugih Ëimbenika ovu bolest, naveli su nas na ovo istraaeivanje.…”

Section: Uvodunclassified

“…This is demonstrated by the fact that women with CAD are on the average hospitalized at the age of 68, while the men are hospitalized at the age of 61. 8 Pathological coronarogram is five times more common in men, but in case it is diagnosed, men have better results after the percutaneous coronary intervention procedure (PCI) [9][10][11][12] . The above-mentioned large epidemiological significance of CAD, differences in the prevalence of the disease, and the need for defining the impact of some other factors on this disease made us conduct this investigation.…”

Section: Introductionmentioning

confidence: 99%