Gender Particularities and Prevalence of Atypical Clinical Presentation in Non-ST Elevation Acute Coronary Syndrome

Abstract

Clinical presentation is one of the factors that can influence how quickly a patient with an acute coronary syndrome is treated, particularly if it is atypical. The purposes of this study are to explore gender-related differences in patients presenting with non-ST elevation acute coronary syndromes (NSTEACS) from the perspective of a series of common risk factors as well as treatment strategies and to evaluate the prevalence of atypical clinical presentation of NSTEACS in the study group. In addition, we explored the differences between the two entities that define NSTEACS: unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI). We conducted a retrospective study by reviewing discharge documents of patients admitted in the cardiology department of the Clinical Rehabilitation Hospital in Cluj-Napoca with NSTEACS between January 2014 and December 2015. We retrieved demographic data, clinical presentation and history, laboratory tests, and coronary angiography records as well as the implemented treatment strategies. Women in the study group were more frequently hypertensive than men (89.5% vs. 75.4%; p = 0.043), had a higher mean serum HDL cholesterol value (43 vs. 38 mg/dL p = 0.022), were more frequently diagnosed with microvascular coronary heart disease (32% vs. 9.8%, p = 0.036), and were more often treated conservatively (49.1% vs. 30.8%, p = 0.038), while men were significantly more prone to smoking than women (30.8% vs. 14%, p = 0.028) and had higher mean serum creatinine (1.2 vs. 0.8 mg/dL; p = 0.022) and uric acid values (6.9 vs. 6.2 mg/dL; p = 0.048). Out of the 122 included patients, 109 had documented information regarding symptoms. The prevalence of atypical presentation was 4.6% (95% CI 0.7–8.5%). In our study group, patients with UA had a more frequent history of cardiovascular ischemic diseases (77.4% vs. 56.7%, p = 0.015), the mean value for BUN was higher in NSTEMI patients compared to patients with UA (47 vs. 39 mg/dL, p = 0.038) and NSTEMI patients more frequently received interventional treatment compared to patients with UA (60% vs. 41.9%; p = 0.046).

The impact of parental consanguineous marriage on the incidence rate, incidence age, and severity of coronary artery disease

“…The present study, similar to previous studies (1, 10, 18), showed that FH, DLP, Smoking, and male gender increase the incidence of CAD and decrease the age of occurrence. It seems that the reason for the increase in the age of the disease in hypertensive patients is the following: a) The average age of hypertensive patients in this study was higher than the average age of the onset of the disease (23-25), b) Hypertensive patients experience chest pain more atypically and therefore refer for angiography later (26) c) Hypertensive patients become symptomatic later due to the formation of coronary collateral vessels and therefore refer to angiography later (27,28), and d) Hypertensive patients receive more primary prevention strategies (23). In this study, diabetes also slightly and insigni cantly increased the age of onset of the disease, and the above reasons also apply to diabetic patients.…”

The Influence of Sex, Age, and Race on Coronary Artery Disease: A Narrative Review

“…Typical symptoms of CAD include central oppressive chest pain, jaw and left arm pain, diaphoresis, shortness of breath, nausea, and vomiting [5][6][7][8][9][10]. Atypical symptoms include fatigue, epigastric pain, dull or burning pain, palpitations, lightheadedness, neck pain, indigestion, shoulder pain, right arm pain, back pain, dizziness, or even syncope.…”

“…Atypical symptoms include fatigue, epigastric pain, dull or burning pain, palpitations, lightheadedness, neck pain, indigestion, shoulder pain, right arm pain, back pain, dizziness, or even syncope. Atypical symptoms are more prevalent in women and diabetic patients, and these symptoms are usually overlooked by healthcare providers [5][6][7][8][9][10][11][12]. A study suggests that labeling symptoms as 'typical' or 'atypical' should no longer be done as the presentation of CAD varies with age, sex, race, and other preexisting risk factors [8].…”

Women’s Cardiovascular Health: Prioritizing the Majority Minority

“…ACS presentation can be due to microvascular disease or plaque rupture in women [ 16 ]. Spontaneous coronary artery dissection is a particular morbid form of ACS associated with arteriopathies, and is most common late in pregnancy or postpartum [ 17 , 18 ].…”