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Research Article| Volume 264, P7-11, August 01, 2018

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Gender differences in symptom presentation of ST-elevation myocardial infarction – An observational multicenter survey study

  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Sofia Sederholm Lawesson
    Correspondence
    Corresponding author at: Department of Cardiology, Linköping University Hospital, SE-581 85 Linköping, Sweden.
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Rose-Marie Isaksson
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Research, Norrbotten County Council, Luleå, Sweden

    Division of Nursing Sciences, Department of Medicine and Health Sciences, Linkoping University, Linköping, Sweden
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Ingela Thylén
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Maria Ericsson
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Karin Ängerud
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Cardiology, Heart Centre, Department of Nursing, Umeå University, Umeå, Sweden
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Eva Swahn
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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  • on behalf of theSymTime Study Group
  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

      Highlights

      • Female sex was strongly predicting non-chest pain presentation in STEMI (OR 5.3, 95% CI 2.6–9.8).
      • In women shoulder (33 vs 15%), throat (34 vs 18%) and back pain (29 vs 12%) was twice as common as in men.
      • Nausea was prevalent in half of the women compared to less than a third of the men (49 vs 29%).
      • The total burden of both chief complaints and associated symptoms were higher in women than in men.
      • Women less often interpreted their symptoms as of cardiac origin (60 vs 69%).

      Abstract

      Background

      Symptom presentation has been sparsely studied from a gender perspective restricting the inclusion to ST elevation myocardial infarction (STEMI) patients. Correct symptom recognition is vital in order to promptly seek care in STEMI where fast reperfusion therapy is of utmost importance. Female gender has been found associated with atypical presentation in studies on mixed MI populations but it is unclear whether this is valid also in STEMI.

      Objectives

      We assessed whether there are gender differences in symptoms and interpretation of these in STEMI, and if this is attributable to sociodemographic and clinical factors.

      Methods

      SymTime was a multicenter observational study including a validated questionnaire and data from medical records. Eligible STEMI patients (n = 532) were enrolled within 24 h after admittance at five Swedish hospitals.

      Results

      Women were older, more often single and had lower educational level. Chest pain was less prevalent in women (74 vs 93%, p < 0.001), whereas shoulder (33 vs 15%, p < 0.001), throat/neck (34 vs 18%, p < 0.001), back pain (29 versus 12%, p < 0.001) and nausea (49 vs 29%, p < 0.001) were more prevalent. Women less often interpreted their symptoms as of cardiac origin (60 vs 69%, p = 0.04). Female gender was the strongest independent predictor of non-chest pain presentation, odds ratio 5.29, 95% confidence interval 2.85–9.80.

      Conclusions

      A striking gender difference in STEMI symptoms was found. As women significantly misinterpreted their symptoms more often, it is vital when informing about MI to the society or to high risk individuals, to highlight also other symptoms than just chest pain.

      Keywords

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