Sex-Specific Chest Pain Characteristics in the Early Diagnosis of Acute Myocardial Infarction
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...
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| Veröffentlicht in: | JAMA internal medicine 2014-02, Vol.174 (2), p.241-249 |
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| creator | 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 |
| description | 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 |
| doi_str_mv | 10.1001/jamainternmed.2013.12199 |
| format | Article |
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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</description><identifier>ISSN: 2168-6106</identifier><identifier>EISSN: 2168-6114</identifier><identifier>DOI: 10.1001/jamainternmed.2013.12199</identifier><identifier>PMID: 24275751</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Cardiology. Vascular system ; Chest Pain - diagnosis ; Chest Pain - epidemiology ; Chest Pain - etiology ; Coronary heart disease ; Diagnosis, Differential ; Early Diagnosis ; Electrocardiography ; Female ; Follow-Up Studies ; General aspects ; Heart ; Humans ; Incidence ; Male ; Medical sciences ; Middle Aged ; Myocardial Infarction - diagnosis ; Myocardial Infarction - epidemiology ; Myocarditis. Cardiomyopathies ; Prognosis ; Prospective Studies ; Risk Factors ; Sex Distribution ; Sex Factors ; Switzerland - epidemiology</subject><ispartof>JAMA internal medicine, 2014-02, Vol.174 (2), p.241-249</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a480t-33f723712d7afa5a9b9bfad4cea6a7ffa4d085cbb3f99c0c54b5c6a097bade5b3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jamainternalmedicine/articlepdf/10.1001/jamainternmed.2013.12199$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2013.12199$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,776,780,3327,27901,27902,76231,76234</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28113061$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24275751$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rubini Gimenez, Maria</creatorcontrib><creatorcontrib>Reiter, Miriam</creatorcontrib><creatorcontrib>Twerenbold, Raphael</creatorcontrib><creatorcontrib>Reichlin, Tobias</creatorcontrib><creatorcontrib>Wildi, Karin</creatorcontrib><creatorcontrib>Haaf, Philip</creatorcontrib><creatorcontrib>Wicki, Katharina</creatorcontrib><creatorcontrib>Zellweger, Christa</creatorcontrib><creatorcontrib>Hoeller, Rebeca</creatorcontrib><creatorcontrib>Moehring, Berit</creatorcontrib><creatorcontrib>Sou, Seoung Mann</creatorcontrib><creatorcontrib>Mueller, Mira</creatorcontrib><creatorcontrib>Denhaerynck, Kris</creatorcontrib><creatorcontrib>Meller, Bernadette</creatorcontrib><creatorcontrib>Stallone, Fabio</creatorcontrib><creatorcontrib>Henseler, Sarah</creatorcontrib><creatorcontrib>Bassetti, Stefano</creatorcontrib><creatorcontrib>Geigy, Nicolas</creatorcontrib><creatorcontrib>Osswald, Stefan</creatorcontrib><creatorcontrib>Mueller, Christian</creatorcontrib><title>Sex-Specific Chest Pain Characteristics in the Early Diagnosis of Acute Myocardial Infarction</title><title>JAMA internal medicine</title><addtitle>JAMA Intern Med</addtitle><description>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</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Chest Pain - diagnosis</subject><subject>Chest Pain - epidemiology</subject><subject>Chest Pain - etiology</subject><subject>Coronary heart disease</subject><subject>Diagnosis, Differential</subject><subject>Early Diagnosis</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>General aspects</subject><subject>Heart</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Myocardial Infarction - epidemiology</subject><subject>Myocarditis. Cardiomyopathies</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Sex Distribution</subject><subject>Sex Factors</subject><subject>Switzerland - epidemiology</subject><issn>2168-6106</issn><issn>2168-6114</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkE1LAzEQhoMottT-AQ-Si-Bla7LJfuRYatVCRaF6lGU2m9iU_ajJLth_b9ZWi7lkyDwzL3kQwpRMKCH0dgMVmLpVtq5UMQkJZRMaUiFO0DCkcRrElPLTv5rEAzR2bkP8SQnhjJ2jQcjDJEoiOkTvK_UVrLZKGm0knq2Va_GLX-9LsCB9inGtkQ77p3at8BxsucN3Bj7qxhmHG42nsmsVfto1EmxhoMSLWoOVrWnqC3SmoXRqfLhH6O1-_jp7DJbPD4vZdBkAT0kbMKaTkCU0LBLQEIHIRa6h4FJBDInWwAuSRjLPmRZCEhnxPJIxEJHkUKgoZyN0s9-7tc1n5_-QVcZJVZZQq6ZzGeVCUBZzJjya7lFpG-es0tnWmgrsLqMk6_1m__xmvd_sx68fvTqkdHnf-h38temB6wMATkKpLdTSuCOXUspI3HOXe84nHeOTlPku-wZAqZE0</recordid><startdate>20140201</startdate><enddate>20140201</enddate><creator>Rubini Gimenez, Maria</creator><creator>Reiter, Miriam</creator><creator>Twerenbold, Raphael</creator><creator>Reichlin, Tobias</creator><creator>Wildi, Karin</creator><creator>Haaf, Philip</creator><creator>Wicki, Katharina</creator><creator>Zellweger, Christa</creator><creator>Hoeller, Rebeca</creator><creator>Moehring, Berit</creator><creator>Sou, Seoung Mann</creator><creator>Mueller, Mira</creator><creator>Denhaerynck, Kris</creator><creator>Meller, Bernadette</creator><creator>Stallone, Fabio</creator><creator>Henseler, Sarah</creator><creator>Bassetti, Stefano</creator><creator>Geigy, Nicolas</creator><creator>Osswald, Stefan</creator><creator>Mueller, Christian</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140201</creationdate><title>Sex-Specific Chest Pain Characteristics in the Early Diagnosis of Acute Myocardial Infarction</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a480t-33f723712d7afa5a9b9bfad4cea6a7ffa4d085cbb3f99c0c54b5c6a097bade5b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Chest Pain - diagnosis</topic><topic>Chest Pain - epidemiology</topic><topic>Chest Pain - etiology</topic><topic>Coronary heart disease</topic><topic>Diagnosis, Differential</topic><topic>Early Diagnosis</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>General aspects</topic><topic>Heart</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Myocardial Infarction - epidemiology</topic><topic>Myocarditis. 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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</abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>24275751</pmid><doi>10.1001/jamainternmed.2013.12199</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Biological and medical sciences Cardiology. Vascular system Chest Pain - diagnosis Chest Pain - epidemiology Chest Pain - etiology Coronary heart disease Diagnosis, Differential Early Diagnosis Electrocardiography Female Follow-Up Studies General aspects Heart Humans Incidence Male Medical sciences Middle Aged Myocardial Infarction - diagnosis Myocardial Infarction - epidemiology Myocarditis. Cardiomyopathies Prognosis Prospective Studies Risk Factors Sex Distribution Sex Factors Switzerland - epidemiology |
| title | Sex-Specific Chest Pain Characteristics in the Early Diagnosis of Acute Myocardial Infarction |
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