October 1st, 2013

ACS Symptoms in Young Patients: Be Aware of Sex Differences

CardioExchange’s Editor-in-Chief, Harlan Krumholz, interviewed author Louise Pilote about the GENESIS PRAXY research group’s JAMA: Internal Medicine study, which examined sex differences in acute coronary syndrome (ACS) presentation and the associations between sex, sociodemographic, gender identity, psychosocial, and clinical factors, markers of coronary disease severity, and absence of chest pain in young patients with ACS. The researchers found that chest pain was the most common ACS symptom in both sexes. Women were more likely to present without chest pain than men, however, the absence of chest pain was not associated with markers of coronary disease severity.

Krumholz: You find that chest pain is a common presentation for young women with acute myocardial infarction. Why do you think that your findings are so different from the NRMI study published in JAMA?

Pilote: The NRMI study also found that chest pain was common among women, but the NRMI obtained data on chest pain symptoms from chart review. PRAXY obtained data on many symptoms at presentation from a patient questionnaire.

NRMI ended data collection in 2006. PRAXY is current. Perhaps women today are more aware of symptoms and recognize and report chest pain as a heart attack symptom.

Krumholz:  You say that “Strategies that explicitly incorporate assessment of common non-chest pain symptoms need to be evaluated.” What kind of strategies do you mean?

Pilote: Education strategies for high-risk young women must help them to recognize their risk of ACS. Also, the evaluation of triage strategies in the ER that would require EKG and biomarker testing in high-risk young women who present with non-chest pain symptoms.

Krumholz:  Are there important implications of your study for clinicians?

Pilote: Young women do get ACS. Education and risk-factor reduction must be a priority. Non-chest pain symptoms in high-risk women must be evaluated.

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