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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

References

REFERENCES

1.Pitts, SR, Niska, RW, Xu, J, et al. National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary. Natl Health Stat Report 2008;6:1–38.Google Scholar
2.Zaman, J, Junghans, C, Sekhri, N, et al. Presentation of stable angina pectoris among women and South Asian people. CMAJ 2008;179:659–67.Google Scholar
3.Chang, AM, Mumma, B, Sease, KL, et al. Gender bias in cardiovascular testing persists after adjustment for presenting characteristics and cardiac risk. Acad Emerg Med 2007;14:599–605.CrossRefGoogle ScholarPubMed
4.Nante, N, Messina, G, Cecchini, M, et al. Sex differences in use of interventional cardiology persist after risk adjustment. J Epidemiol Community Health 2009;63:203–8.Google Scholar
5.Rathore, SS, Chen, J, Wang, Y, et al. Sex differences in cardiac catheterization: the role of physician gender. JAMA 2001;286:2849–56.Google Scholar
6.Silbergleit, R, McNamara, RM. Effect of gender on the emergency department evaluation of patients with chest pain. Acad Emerg Med 1995;2:115–9.Google Scholar
7.Kaul, P, Chang, WC, Westerhout, CM, et al. Differences in admission rates and outcomes between men and women presenting to emergency departments with coronary syndromes. CMAJ 2007;177:1193–9.Google Scholar
8.Hollander, JE, Blomkalns, AL, Brogan, GX, et al. Standardized reporting guidelines for studies evaluating risk stratification of ED patients with potential acute coronary syndromes. Acad Emerg Med 2004;11:1331–40.Google Scholar
9.Shaw, LJ, Shaw, RE, Merz, CN, et al. Impact of ethnicity and gender differences on angiographic coronary artery disease prevalence and in-hospital mortality in the American College of Cardiology-National Cardiovascular Data Registry. Circulation 2008;117:1787–801.Google Scholar
10.Brown, AM, Sease, KL, Robey, JL, et al. The risk for acute coronary syndrome associated with atrial fibrillation among ED patients with chest pain syndromes. Am J Emerg Med 2007;25:523–8.Google Scholar
11.Thygesen, K, Alpert, JS, White, HD. Joint ESC/ACCF/AHA/ WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction. Circulation 2007;116:1–20.Google Scholar
12.Macrae, AR, Kavsak, PA, Lustig, V, et al. Assessing the requirement for the 6-hour interval between specimens in the American Heart Association Classification of Myocardial Infarction in Epidemiology and Clinical Research Studies. Clin Chem 2006;52:812–8.Google Scholar
13.Peduzzi, P, Concato, J, Kemper, E, et al. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996;49:1373–9.Google Scholar
14.Patel, H, Rosengren, A, Ekman, I. Symptoms in acute coronary syndromes: Does sex make a difference? Am Heart J 2004;148:27–33.CrossRefGoogle Scholar
15.Milner, KA, Vaccarino, V, Arnold, AL, et al. Gender and age differences in chief complaints of acute myocardial infarction (Worcester Heart Attack Study). Am J Cardiol 2004;93:606–8.Google Scholar
16.Canto, JG, Goldberg, RJ, Hand, MM, et al. Symptom presentation of women with acute coronary syndromes: myth vs. reality. Arch Intern Med 2007;167:2405–13.Google Scholar
17.DeVon, HA, Zerwic, JJ. Symptoms of acute coronary syndromes: Are there gender differences? A review of the literature. Heart Lung 2002;31:235–45.CrossRefGoogle ScholarPubMed