Gender differences in symptom predictors associated with acute coronary syndrome: A prospective observational study

•Diabetes was a common risk factor of ACS among men and women with ACS diagnosis.•Typical symptoms such as chest symptoms, diaphoresis and dyspnea are more common symptom predictors of ACS in men than women.•The number of typical symptoms was more predictive of ACS in men than women.•Understanding the factors related to symptom predictors may help in the earlier detection and more appropriate medical treatments of the patients with ACS. Signs and symptoms (typical and atypical symptoms) of acute coronary syndromes (ACS) differ between men and women. Identification of gender differences has implications for both health care providers and the general public. The aim of this study was to determine the symptom predictors of the acute coronary syndromes in men and women. In this prospective study, nurse data collectors directly observed 256 men and 182 women (N = 438) with symptoms suggestive of ACS in the Emergency Departments of eight hospitals in Tehran. ACS was eventually diagnosed in 183 (57.2%) men and 137 (42.8%) women on the basis of standard electrocardiogram and cardiac enzyme (CPK-MB) level. In men, chest symptoms (OR = 3.22, CI = 0.137–0.756, P = 0.009), dyspnea (OR = 2.65, CI = 1.78–4.123 P = 0.001) and diaphoresis (OR = 2.175, CI = 1.020–4.639, P = 0.044) were significantly associated with the diagnosis of ACS 3.78, 2.72 and 1.87 times more than in women having these symptoms, respectively. These results indicated that chest symptoms, diaphoresis and dyspnea were the more pronounced typical symptoms of ACS in men compared to women. Additionally, the numbers of typical symptoms can be considered as more predictive of ACS in men (OR = 1.673, CI = 1.211–2.224, P