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Sex differences in clinical presentation, management and outcome in emergency department patients with chest pain

Published online by Cambridge University Press:  21 May 2015

Erik P. Hess ,
Jeffrey J. Perry ,
Lisa A. Calder ,
Venkatesh Thiruganasambandamoorthy ,
Veronique L. Roger ,
George A. Wells  and
Ian G. Stiell
Erik P. Hess*
Affiliation:
Department of Emergency Medicine, Division of Emergency Medicine Research, Mayo Clinic College of Medicine, Rochester, Minn.
Jeffrey J. Perry
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont. Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont.
Lisa A. Calder
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont. Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont.
Venkatesh Thiruganasambandamoorthy
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont. Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont.
Veronique L. Roger
Affiliation:
Department of Internal Medicine, Division of Cardiology, Mayo Clinic College of Medicine, Rochester, Minn.
George A. Wells
Affiliation:
Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont.
Ian G. Stiell
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont. Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont.
*
Department of Emergency Medicine, Division of Emergency Medicine Research, Mayo Clinic College of Medicine, 200 First St. SW, Rochester MN 55905; hess.erik@mayo.edu

Abstract

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Objective:

We sought to assess sex differences in clinical presentation, management and outcome in emergency department (ED) patients with chest pain, and to measure the association between female sex and coronary angiography within 30 days.

Methods:

We conducted a prospective cohort study in an urban academic ED between Jul. 1, 2007, and Apr. 1, 2008. We enrolled patients over 24 years of age with chest pain and possible acute coronary syndrome (ACS).

Results:

Among the 970 included patients, 386 (39.8%) were female. Compared with men, women had a lower prevalence of known coronary artery disease (21.0% v. 34.2%, p < 0.001) and a lower frequency of typical pain (37.1% v. 45.7%, p = 0.01). Clinicians classified a greater proportion of women as having a low (< 10%) pretest probability for ACS (85.0% v. 76.4%, p = 0.001). Despite similar rates of electrocardiography, troponin T and stress testing between sexes, there was a lower rate of acute myocardial infarction (AMI) (4.7% v. 8.4%, p = 0.03) and positive stress test results (4.4% v. 7.9%, p = 0.03) in women. Women were less frequently referred for coronary angiography (9.3% v. 18.9%, p < 0.001). The adjusted association between female sex and coronary angiography was not significant (odds ratio 0.63, 95% confidence interval 0.37–1.10).

Conclusion:

Women had a lower rate of AMI and a lower rate of positive stress test results despite similar rates of testing between sexes. Although women were less frequently referred for coronary angiography, these data suggest that sex differences in management were likely appropriate for the probability of disease.

Keywords

sex differencesacute coronary syndromemyocardial infarctionunstable anginadiagnosis
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 5 , September 2010 , pp. 405 - 413
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

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