Sex Differences in Acute Coronary Syndrome Symptom Presentation in Young Patients

被引：170

作者：

Khan, Nadia A. ^{[1
]}

Daskalopoulou, Stella S. ^{[2
,10
]}

Karp, Igor ^{[3
,4
]}

Eisenberg, Mark J. ^{[5
,6
]}

Pelletier, Roxanne ^{[2
,11
]}

Tsadok, Meytal Avgil ^{[2
,11
]}

Dasgupta, Kaberi ^{[2
,10
,11
]}

Norris, Colleen M. ^{[7
,8
,9
]}

Pilote, Louise ^{[2
,10
,11
]}

机构：

[1] Univ British Columbia, Ctr Hlth Evaluat & Outcomes Sci, Dept Med, Vancouver, BC V5Z 1M9, Canada

[2] McGill Univ, Ctr Hlth, Res Inst, Montreal, PQ H3A 1A1, Canada

[3] Univ Montreal, Univ Montreal Hosp, Res Ctr, Montreal, PQ, Canada

[4] Univ Montreal, Dept Social & Prevent Med, Montreal, PQ, Canada

[5] McGill Univ, Jewish Gen Hosp, Div Cardiol, Montreal, PQ H3T 1E2, Canada

[6] McGill Univ, Jewish Gen Hosp, Div Clin Epidemiol, Montreal, PQ H3T 1E2, Canada

[7] Univ Alberta, Fac Nursing, Edmonton, AB, Canada

[8] Univ Alberta, Fac Med, Edmonton, AB, Canada

[9] Univ Alberta, Sch Publ Hlth, Edmonton, AB, Canada

[10] McGill Univ, Ctr Hlth, Div Gen Internal Med, Montreal, PQ H3A 1A1, Canada

[11] McGill Univ, Ctr Hlth, Div Clin Epidemiol, Montreal, PQ H3A 1A1, Canada

来源：

JAMA INTERNAL MEDICINE | 2013年 / 173卷 / 20期

基金：

加拿大健康研究院;

关键词：

ACUTE MYOCARDIAL-INFARCTION; GENDER-DIFFERENCES; WOMEN; RISK; PAIN; MEN;

D O I：

10.1001/jamainternmed.2013.10149

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：1863 / 1871

页数：9

共 23 条

[1] Symptoms of men and women presenting with acute coronary syndromes [J].