Sex differences in clinical presentation, management and outcome in emergency department patients with chest pain.
OBJECTIVE
We sought to assess sex differences in clinical presentation, management and outcome in emergency department (ED) patients with chest pain, and to measure the association between female sex and coronary angiography within 30 days.


METHODS
We conducted a prospective cohort study in an urban academic ED between Jul. 1, 2007, and Apr. 1, 2008. We enrolled patients over 24 years of age with chest pain and possible acute coronary syndrome (ACS).


RESULTS
Among the 970 included patients, 386 (39.8%) were female. Compared with men, women had a lower prevalence of known coronary artery disease (21.0% v. 34.2%, p < 0.001) and a lower frequency of typical pain (37.1% v. 45.7%, p = 0.01). Clinicians classified a greater proportion of women as having a low (< 10%) pretest probability for ACS (85.0% v. 76.4%, p = 0.001). Despite similar rates of electrocardiography, troponin T and stress testing between sexes, there was a lower rate of acute myocardial infarction (AMI) (4.7% v. 8.4%, p = 0.03) and positive stress test results (4.4% v. 7.9%, p = 0.03) in women. Women were less frequently referred for coronary angiography (9.3% v. 18.9%, p < 0.001). The adjusted association between female sex and coronary angiography was not significant (odds ratio 0.63, 95% confidence interval 0.37-1.10).


CONCLUSIONS
Women had a lower rate of AMI and a lower rate of positive stress test results despite similar rates of testing between sexes. Although women were less frequently referred for coronary angiography, these data suggest that sex differences in management were likely appropriate for the probability of disease.
Hess
Erik P
EP
Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, United States of America. hess.erik@mayo.edu
Perry
Jeffery J
JJ
Calder
Lisa A
LA
Thiruganasambandamoorthy
Venkatesh
V
Roger
Veronique L
VL
Wells
George A
GA
Stiell
Ian G
IG
D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000503:physiopathology; D019540:Area Under Curve; D002637:Chest Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D004636:Emergency Service, Hospital; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
D020107:Troponin T