Sex-Specific Chest Pain Characteristics in AMI Jay Mansfield, Pgy-3 July 22, 2014 LSU Journal Club Gimenez, M, et. Al. Jama Int Med. 2014;174(2): November 2013.

Background Symptoms concerning for acute myocardial infarction accounts for ~10% of all ED visits – 90% have a chief complaint of chest pain/discomfort Of these, only ~10-20% have an actual AMI Our tools for diagnosis include medical history/risk factors, EKGs, cardiac troponin assay and chest pain characteristics (CPCs)

Background Sex-specific differences have been observed to detriement women – Delayed diagnosis, misdiagnosis, higher AMI mortality rate, and possibly less benefit from early PCI Large amounts of data have shown that women with AMI may differ from men with AMI, so…..

Research question Can we use sex-specific CPCs to differentiate women with AMI from those with non-cardiac CP, and how do they relate to men with certain CPCs? Answering this question can aid us in more accurate and timely use of medical therapy in women and men with AMI

Study design Organized by Advantageous Predictors of Acute Coronary Sydrome Evaluation (APACE) Prospective trial aimed at diagnosis in early AMI Nine different centers in Europe, last from Each case was reviewed using conventional cardiac troponin assay (cTn) followed by a second high-sensitivity cTn (hs-cTn) – AMI was defined as cTn >99th percentile or cTn >10% over imprecision value if not 99 th percentile – This had to be in conjunction with clinical picture All recordes were also reviewed independently by 3 separate cardiologists 90-days after the episode

Study Subjects Inclusion criteria – Men and women with age >18 with chest pain or discomfort that had onset or peaked within 12 hours of presentation Exclusion criteria – Anyone with ESRD on regular HD 2475 patients included – 32% women, 68% men AMI found in 143 women and 369 men

Chest Pain Characteristics Quality Aggravating, alleviating factors Localization, size Radiation Onset, duration, dynamics Prior episodes Severity 34 Total

Results

Only 3 CPCs were significantly different – Pain 2-30 minutes and decreasing pain lower risk for AMI in women – Duration > 30 minutes increased risk in men

Conclusions 1) Although most presentations are similar between men and women 11/34 CPCs are sex- specific 2) Most assessed CPCs did not differentiate AMI from other causes of CP in women or men 3) Differences in sex-specific diagnostic performances of CPCs are overall small