- •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%).
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.
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.
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.
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.
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.
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- Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain.JAMA. 2000; 283: 3223-3229
- Factors related to delay times in patients with suspected acute myocardial infarction.Heart Lung. 2004; 33: 291-300
- A gender perspective on short- and long term mortality in ST-elevation myocardial infarction—a report from the SWEDEHEART register.Int. J. Cardiol. 2013; 168: 1041-1047
- Symptoms and type of symptom onset in acute coronary syndrome in relation to ST elevation, sex, age, and a history of diabetes.Am. Heart J. 2005; 150: 234-242
- Symptom presentation of acute myocardial infarction: influence of sex, age, and risk factors.Am. Heart J. 2002; 144: 1012-1017
- Symptoms of a first acute myocardial infarction in women and men.Gend. Med. 2009; 6: 454-462
- Time trends in symptoms and prehospital delay time in women vs. men with myocardial infarction over a 15-year period. The Northern Sweden MONICA Study.Eur. J. Cardiovasc. Nurs. 2008; 7: 152-158
- Gender and age differences in chief complaints of acute myocardial infarction (Worcester Heart Attack Study).Am. J. Cardiol. 2004; 93: 606-608
- Sex differences in acute coronary syndrome symptom presentation in young patients.JAMA Intern. Med. 2013; 173: 1863-1871
- First medical contact in patients with STEMI and its impact on time to diagnosis; an explorative cross-sectional study.BMJ Open. 2015; 5e007059
- 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC).Eur. Heart J. 2018; 39: 119-177
- World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.JAMA. 2013; 310: 2191-2194
- The Swedish Web-system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies (SWEDEHEART).Heart. 2010; 96: 1617-1621
- Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality.JAMA. 2012; 307: 813-822
- Sex differences in patient-reported symptoms associated with myocardial infarction (from the population-based MONICA/KORA Myocardial Infarction Registry).Am. J. Cardiol. 2011; 107: 1585-1589
- Time trends in STEMI—improved treatment and outcome but still a gender gap: a prospective observational cohort study from the SWEDEHEART register.BMJ Open. 2012; 2e000726
- Understanding treatment-seeking delay in women with acute myocardial infarction: descriptions of decision-making patterns.Am. J. Crit. Care. 2005; 14: 285-293
- National study of women's awareness, preventive action, and barriers to cardiovascular health.Circulation. 2006; 113: 525-534
- Knowledge of heart attack symptoms in 20 US communities. Results from the Rapid Early Action for Coronary Treatment Community Trial.Prev. Med. 2004; 38: 85-93
- Acute coronary syndrome: what do patients know?.Arch. Intern. Med. 2008; 168: 1049-1054
- Sex-related differences in the presentation, treatment and outcomes among patients with acute coronary syndromes: the Global Registry of Acute Coronary Events.Heart. 2009; 95: 20-26
- Symptoms of men and women presenting with acute coronary syndromes.Am. J. Cardiol. 2006; 98: 1177-1181
- Sex, clinical presentation, and outcome in patients with acute coronary syndromes. Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes IIb Investigators.N. Engl. J. Med. 1999; 341: 226-232
- Differences in symptom presentation and hospital mortality according to type of acute myocardial infarction.Am. Heart J. 2012; 163: 572-579
- Differences in symptoms, first medical contact and pre-hospital delay times between patients with ST- and non-ST-elevation myocardial infarction.Eur. Heart J. Acute Cardiovasc. Care. 2017; https://doi.org/10.1177/2048872617741734
- Sex differences in mortality following acute coronary syndromes.JAMA. 2009; 302: 874-882
- Effect of gender on patients with ST-elevation and non-ST-elevation myocardial infarction without obstructive coronary artery disease.Am. J. Cardiol. 2015; 115: 1661-1666
- Differences between men and women in terms of clinical features of ST-segment elevation acute myocardial infarction.Circ. J. 2006; 70: 222-226
- Meta-analytic evaluation of gender differences and symptom measurement strategies in acute coronary syndromes.Heart Lung. 2010; 39: 283-295
- Are manual gestures, verbal descriptors and pain radiation as reported by patients reliable indicators of myocardial infarction? Preliminary findings and implications.Intensiv Crit. Care Nurs. 2000; 16: 98-110
- Gender perspective on risk factors, coronary lesions and long-term outcome in young patients with ST-elevation myocardial infarction.Heart. 2010; 96: 453-459
- Effect of menopause on plaque morphologic characteristics in coronary atherosclerosis.Am. Heart J. 2001; 141: S58-62
- The influence of gender on short- and long-term outcome after primary PCI and delivered medical care for ST-segment elevation myocardial infarction.EuroIntervention. 2010; 5: 780-787
Published online: March 26, 2018
Accepted: March 16, 2018
Received in revised form: March 14, 2018
Received: October 25, 2017
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