title: Sex-specific chest pain characteristics in the early diagnosis of acute myocardial infarction.
abstract: OBJECTIVE
  Whether sex-specific chest pain characteristics (CPCs) would allow physicians in the emergency department to differentiate women with acute myocardial infarction (AMI) from women with other causes of acute chest pain more accurately remains unknown. OBJECTIVE To improve the management of suspected AMI in women by exploring sex-specific CPCs.
  
  
  METHODS
  From April 21, 2006, through August 12, 2012, we enrolled 2475 consecutive patients (796 women and 1679 men) presenting with acute chest pain to 9 emergency departments in a prospective multicenter study. The final diagnosis of AMI was adjudicated by 2 independent cardiologists.
  
  
  METHODS
  Treatment of AMI in the emergency department.
  
  
  METHODS
  Sex-specific diagnostic performance of 34 predefined and uniformly recorded CPCs in the early diagnosis of AMI.
  
  
  RESULTS
  Acute myocardial infarction was the adjudicated final diagnosis in 143 women (18.0%) and 369 men (22.0%). Although most CPCs were reported with similar frequency in women and men, several CPCs were reported more frequently in women (P < .05). The accuracy of most CPCs in the diagnosis of AMI was low in women and men, with likelihood ratios close to 1. Thirty-one of 34 CPCs (91.2%) showed similar likelihood ratios for the diagnosis of AMI in women and men, and only 3 CPCs (8.8%) seemed to have a sex-specific diagnostic performance with P < .05 for interaction. These CPCs were related to pain duration (2-30 and >30 minutes) and dynamics (decreasing pain intensity). However, because their likelihood ratios were close to 1, the 3 CPCs did not seem clinically helpful. Similar results were obtained when examining combinations of CPCs (all interactions, P ≥ .05).
  
  
  CONCLUSIONS
  Differences in the sex-specific diagnostic performance of CPCs are small and do not seem to support the use of women-specific CPCs in the early diagnosis of AMI. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00470587.
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland2Servicio de Urgencias y Pneumologia, Ciber de Enfermedades Raras, Carles III Institute for Health, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Rubini Gimenez
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Miriam
authors.initials: M
authors.lastname: Reiter
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland3Department of Cardiology, Universitäres Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland4Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland5Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Karin
authors.initials: K
authors.lastname: Wildi
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Philip
authors.initials: P
authors.lastname: Haaf
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Katharina
authors.initials: K
authors.lastname: Wicki
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland5Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Christa
authors.initials: C
authors.lastname: Zellweger
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland5Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Rebeca
authors.initials: R
authors.lastname: Hoeller
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland5Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Berit
authors.initials: B
authors.lastname: Moehring
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland5Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Seoung Mann
authors.initials: SM
authors.lastname: Sou
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Mira
authors.initials: M
authors.lastname: Mueller
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Kris
authors.initials: K
authors.lastname: Denhaerynck
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Meller
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Fabio
authors.initials: F
authors.lastname: Stallone
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Sarah
authors.initials: S
authors.lastname: Henseler
authors.affiliation: Department of Internal Medicine, Medizinische Klinik, Kantonsspital Olten, Olten, Switzerland.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bassetti
authors.affiliation: Department of Internal Medicine, Notfallstation, Kantonsspital Liestal, Liestal, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Geigy
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Osswald
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D013557:Switzerland / Q000453:epidemiology