Sex-specific chest pain characteristics in the early diagnosis of acute myocardial infarction
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Sex-specific chest pain characteristics in the early diagnosis of acute myocardial infarction. / Rubini Gimenez, Maria; Reiter, Miriam; Twerenbold, Raphael; Reichlin, Tobias; Wildi, Karin; Haaf, Philip; Wicki, Katharina; Zellweger, Christa; Hoeller, Rebeca; Moehring, Berit; Sou, Seoung Mann; Mueller, Mira; Denhaerynck, Kris; Meller, Bernadette; Stallone, Fabio; Henseler, Sarah; Bassetti, Stefano; Geigy, Nicolas; Osswald, Stefan; Mueller, Christian.
In: JAMA INTERN MED, Vol. 174, No. 2, 01.02.2014, p. 241-9.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Sex-specific chest pain characteristics in the early diagnosis of acute myocardial infarction
AU - Rubini Gimenez, Maria
AU - Reiter, Miriam
AU - Twerenbold, Raphael
AU - Reichlin, Tobias
AU - Wildi, Karin
AU - Haaf, Philip
AU - Wicki, Katharina
AU - Zellweger, Christa
AU - Hoeller, Rebeca
AU - Moehring, Berit
AU - Sou, Seoung Mann
AU - Mueller, Mira
AU - Denhaerynck, Kris
AU - Meller, Bernadette
AU - Stallone, Fabio
AU - Henseler, Sarah
AU - Bassetti, Stefano
AU - Geigy, Nicolas
AU - Osswald, Stefan
AU - Mueller, Christian
PY - 2014/2/1
Y1 - 2014/2/1
N2 - IMPORTANCE: Whether sex-specific chest pain characteristics (CPCs) would allow physicians in the emergency department to differentiate women with acute myocardial infarction (AMI) from women with other causes of acute chest pain more accurately remains unknown. OBJECTIVE To improve the management of suspected AMI in women by exploring sex-specific CPCs.DESIGN, SETTING, AND PARTICIPANTS: From April 21, 2006, through August 12, 2012, we enrolled 2475 consecutive patients (796 women and 1679 men) presenting with acute chest pain to 9 emergency departments in a prospective multicenter study. The final diagnosis of AMI was adjudicated by 2 independent cardiologists.INTERVENTIONS: Treatment of AMI in the emergency department.MAIN OUTCOMES AND MEASURES: Sex-specific diagnostic performance of 34 predefined and uniformly recorded CPCs in the early diagnosis of AMI.RESULTS: Acute myocardial infarction was the adjudicated final diagnosis in 143 women (18.0%) and 369 men (22.0%). Although most CPCs were reported with similar frequency in women and men, several CPCs were reported more frequently in women (P < .05). The accuracy of most CPCs in the diagnosis of AMI was low in women and men, with likelihood ratios close to 1. Thirty-one of 34 CPCs (91.2%) showed similar likelihood ratios for the diagnosis of AMI in women and men, and only 3 CPCs (8.8%) seemed to have a sex-specific diagnostic performance with P < .05 for interaction. These CPCs were related to pain duration (2-30 and >30 minutes) and dynamics (decreasing pain intensity). However, because their likelihood ratios were close to 1, the 3 CPCs did not seem clinically helpful. Similar results were obtained when examining combinations of CPCs (all interactions, P ≥ .05).CONCLUSIONS AND RELEVANCE: Differences in the sex-specific diagnostic performance of CPCs are small and do not seem to support the use of women-specific CPCs in the early diagnosis of AMI. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00470587.
AB - IMPORTANCE: Whether sex-specific chest pain characteristics (CPCs) would allow physicians in the emergency department to differentiate women with acute myocardial infarction (AMI) from women with other causes of acute chest pain more accurately remains unknown. OBJECTIVE To improve the management of suspected AMI in women by exploring sex-specific CPCs.DESIGN, SETTING, AND PARTICIPANTS: From April 21, 2006, through August 12, 2012, we enrolled 2475 consecutive patients (796 women and 1679 men) presenting with acute chest pain to 9 emergency departments in a prospective multicenter study. The final diagnosis of AMI was adjudicated by 2 independent cardiologists.INTERVENTIONS: Treatment of AMI in the emergency department.MAIN OUTCOMES AND MEASURES: Sex-specific diagnostic performance of 34 predefined and uniformly recorded CPCs in the early diagnosis of AMI.RESULTS: Acute myocardial infarction was the adjudicated final diagnosis in 143 women (18.0%) and 369 men (22.0%). Although most CPCs were reported with similar frequency in women and men, several CPCs were reported more frequently in women (P < .05). The accuracy of most CPCs in the diagnosis of AMI was low in women and men, with likelihood ratios close to 1. Thirty-one of 34 CPCs (91.2%) showed similar likelihood ratios for the diagnosis of AMI in women and men, and only 3 CPCs (8.8%) seemed to have a sex-specific diagnostic performance with P < .05 for interaction. These CPCs were related to pain duration (2-30 and >30 minutes) and dynamics (decreasing pain intensity). However, because their likelihood ratios were close to 1, the 3 CPCs did not seem clinically helpful. Similar results were obtained when examining combinations of CPCs (all interactions, P ≥ .05).CONCLUSIONS AND RELEVANCE: Differences in the sex-specific diagnostic performance of CPCs are small and do not seem to support the use of women-specific CPCs in the early diagnosis of AMI. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00470587.
KW - Adult
KW - Aged
KW - Chest Pain/diagnosis
KW - Diagnosis, Differential
KW - Early Diagnosis
KW - Electrocardiography
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/diagnosis
KW - Prognosis
KW - Prospective Studies
KW - Risk Factors
KW - Sex Distribution
KW - Sex Factors
KW - Switzerland/epidemiology
U2 - 10.1001/jamainternmed.2013.12199
DO - 10.1001/jamainternmed.2013.12199
M3 - SCORING: Journal article
C2 - 24275751
VL - 174
SP - 241
EP - 249
JO - JAMA INTERN MED
JF - JAMA INTERN MED
SN - 2168-6106
IS - 2
ER -
