Gender difference in pain presentation among patients with acute coronary syndrome: A systematic review and meta-analysis

Background: Acute coronary syndrome is the leading cause of death worldwide. Chest pain is vital for immediate diagnosis and intervention. Few studies evaluated the effect of gender on chest pain in the setting of acute coronary syndrome. This meta-analysis assessed gender differences among patients with acute coronary syndrome. Methods: We searched three databases for relevant articles. The searching engine was limited to the period from January 2013 up to January 2023. The keywords acute coronary syndrome, typical chest pain, atypical chest pain, clinical characteristics, gender differences and sex differences were used. Results: Out of the 933 studies, 811 were eligible after the removal of duplication, of them, 64 full texts were screened and only seven studies were included in the final analysis (27886 patients (20301 males and 7585 males)). No difference was evident between women and men regarding chest pain as a symptom of the acute coronary syndrome (odd ratio, 1.24, 95 CI, 0.91-1.70, P-value for overall effect, 0.18). Substantial heterogeneity was found I2 for heterogeneity, 91%, the Chi-square, 64.76, the mean difference=6. In addition, atypical chest pain was not different between males and females (odd ratio, 0.72, 95 CI, 0.48-1.08, P-value for overall effect, 0.11). Substantial heterogeneity was found I2 for heterogeneity, 92%, the Chi-square, 39.48, the mean difference=3. Conclusion: No significant difference was evident across gender regarding chest pain (typical or atypical) among patients with acute coronary syndrome. Future research on diagnostic tools for acute coronary syndrome and focusing on sex differences in chest pain presentation are needed.