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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Article info
Publication history
Published online: March 26, 2018
Accepted:
March 16,
2018
Received in revised form:
March 14,
2018
Received:
October 25,
2017
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
