Presentations of Acute Myocardial Infarction in Men and Women

Abstract

OBJECTIVE:To assess the influence of gender on the likelihood of acute myocardial infarction (AMI) among emergency department (ED) patients with symptoms suggestive of acute cardiac ischemia, and to determine whether any specific presenting signs or symptoms are associated more strongly with AMI in women than in men. DESIGN:Analysis of cohort data from a prospective clinical trial. SETTING:Emergency departments of 10 hospitals of varying sizes and types in the United States. PATIENTS:Patients 30 years of age or older ( n ‫؍‬ 10,525) who presented to the ED with chest pain or other symptoms suggestive of acute cardiac ischemia. MEASUREMENTS AND MAIN RESULTS:The prevalence of AMI was determined for men and women, and a multivariable logistic regression model predicting AMI was developed to adjust for patients' demographic and clinical characteristics. AMI was almost twice as common in men as in women (10% vs 6%). Controlling for demographics, presenting signs and symptoms, electrocardiogram features, and hospital, male gender was a significant predictor of AMI (odds ratio [OR] 1.7; 95% confidence interval [CI] 1.4, 2.0). The gender effect was eliminated, however, among patients with ST-segment elevations on electrocardiogram (OR 1.1; 95% CI 0.7, 1.7) and among patients with signs of congestive heart failure (CHF) (OR 1.1; 95% CI 0.8, 1.5). Signs of CHF were associated with AMI among women (OR 1.9; 95% CI 1.4, 2.6) but not men (OR 1.0; 95% CI 0.8, 1.3). Among patients who presented to EDs with chest pain or other symptoms suggestive of acute cardiac ischemia, AMI was more likely in men than in women. Among women with ST-segment elevation or signs of CHF, however, AMI likelihood was similar to that in men with these characteristics. he benefits of time-dependent therapeutic interventions for acute myocardial infarction (AMI) depend on prompt and accurate diagnosis of AMI by emergency department (ED) physicians. As aids to rapid identification, risk factors, presenting characteristics, and diagnostic test results have been related to the occurrence of AMIs. [1][2][3][4][5][6][7] These can help in assessing a patient's likelihood of AMI, but their predictive value may differ for certain subgroups of patients. 4,[8][9][10] In particular, gender may significantly affect the likelihood of AMI in ED patients with chest pain or other symptoms of acute cardiac ischemia.The incidence of AMI in the general population has been shown to be higher in men than women, 11-14 but it is not clear whether this gender difference holds among symptomatic patients who come to the ED. Knowing whether gender influences the likelihood that a given ED patient is having an AMI and whether any specific presenting signs and symptoms are differentially associated with AMI in women as compared with men could aid ED physicians in the accurate diagnosis of AMI.Several studies have looked at gender differences in the presentation of patients with AMI. [15][16][17][18][19] In a retrospective analysis of patients with confirmed AMI, women had higher ra...

Importance of Manchester Triage in acute myocardial infarction: impact on prognosis

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Epidemiological Profile of Hispanics Admitted With Acute Myocardial Infarction in Puerto Rico: The Experience of 2007, 2009 and 2011

“…These results are similar to those observed in the WHAS (2005) where female patients were more likely to suffer from diabetes mellitus, hypertension, stroke, and CHF; however, no significant difference was found in other comorbidities [12]. In a similar way, Zucker et al (1997) found women to be more likely to suffer from diabetes mellitus (25%) and hypertension (55%) when compared to men [14]. Nedkoff et al (2015) also found women to have a higher prevalence of comorbid conditions such as diabetes mellitus, hypertension, and CHF [13].…”

“…Nevertheless, Zucker et al (1997) observed no difference between gender in STEMI likelihood, but report a higher number of men with ST elevations as compared to women (OR: 1.9; CI: 1.5 - 2.3). Therefore, the gender interaction showed an increase in likelihood of women with ST elevations rather than without [14]. …”

Elapsed Time in Emergency Medical Services for Patients With Cardiac Complaints

“…Though our analysis does not reveal why women were more likely to be delayed, previous research suggests a plausible explanation: symptom presentation in women with cardiac disease differs from that of men18 and a coronary event may not be recognized as readily by the patient19 or by EMS personnel. Inappropriate delays may occur because there is less certainty of cardiac involvement, because more time is spent diagnosing the condition, because the patient’s condition may not be seen as emergent, or as the result of some combination of these factors.…”