An analysis of chest-pain symptoms in almost 2500 men and women presenting with possible Acute myocardial infarction (AMI) to nine European emergency departments indicates that there are no good clues specific to women that could help staff to identify those who are having a heart attack, as opposed to other causes of chest pain.
The study, published online November 25, 2013 in JAMA: Internal Medicine, “clarifies that presentation of chest pain between men and women is not as different as is commonly thought and provides new knowledge on the value and limitation of chest pain in making a diagnosis of AMI in women as well as in men,” an accompanying editorial concludes.
The study, led by Dr Maria Rubini Gimenez (University Hospital Basel, Switzerland), reviewed patient records according to 34 predefined sex-specific chest-pain characteristics. They found that 31 out of the 34 characteristics were equally common in men and women. The three that were more common in women, relating to pain duration (for two minutes or more or 30 minutes or more) as well as decreasing pain intensity, had “likelihood ratios” close to one and so “did not seem clinically helpful,” Gimenez et al report.
The findings run counter to recent studies suggesting that sex-specific characteristics of chest pain might help identify women who are truly suffering from an acute MI, the authors note. Too often, AMI in women goes missed because symptoms are dismissed as noncardiac, but at least in the current study, no clear markers emerged that would suggest there are specific signs that would help refine the diagnosis in women.
“Our findings do not seem to support the use of chest-pain characteristics specific to women in the early diagnosis of AMI in women,” they conclude.
Instead, writes the editorialist Dr Louis Pilote (McGill University, Montreal, QC), “clinicians will have to maintain a high level of clinical suspicion and increasingly use sensitive biomarkers, such as high-sensitivity cardiac troponin tests, to help diagnose AMI in high-risk women.”
Ghana Health Nest