Presentations of acute myocardial infarction in men and women.
OBJECTIVE
To assess the influence of gender on the likelihood of acute myocardial infarction (AMI) among emergency department (ED) patients with symptoms suggestive of acute cardiac ischemia, and to determine whether any specific presenting signs or symptoms are associated more strongly with AMI in women than in men.


METHODS
Analysis of cohort data from a prospective clinical trial.


METHODS
Emergency departments of 10 hospitals of varying sizes and types in the United States.


METHODS
Patients 30 years of age or older (n = 10,525) who presented to the ED with chest pain or other symptoms suggestive of acute cardiac ischemia.


RESULTS
The prevalence of AMI was determined for men and women, and a multivariable logistic regression model predicting AMI was developed to adjust for patients' demographic and clinical characteristics. AMI was almost twice as common in men as in women (10% vs 6%). Controlling for demographics, presenting signs and symptoms, electrocardiogram features, and hospital, male gender was a significant predictor of AMI (odds ratio [OR] 1.7; 95% confidence interval [CI] 1.4, 2.0). The gender effect was eliminated, however, among patients with ST-segment elevations on electrocardiogram (OR 1.1; 95% CI 0.7, 1.7) and among patients with signs of congestive heart failure (CHF) (OR 1.1; 95% CI 0.8, 1.5). Signs of CHF were associated with AMI among women (OR 1.9; 95% CI 1.4, 2.6) but not men (OR 1.0; 95% CI 0.8, 1.3). Among patients who presented to EDs with chest pain or other symptoms suggestive of acute cardiac ischemia, AMI was more likely in men than in women. Among women with ST-segment elevation or signs of CHF, however, AMI likelihood was similar to that in men with these characteristics.
Zucker
D R
DR
Department of Medicine, New England Medical Center, Boston, MA 02111, USA.
Griffith
J L
JL
Beshansky
J R
JR
Selker
H P
HP
D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000150:complications / Q000175:diagnosis; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology; D009325:Nausea / Q000150:complications; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014481:United States; D014839:Vomiting / Q000150:complications