November 26th, 2013
Little Difference in Chest Pain Between Men and Women
In recent years, the medical community has grown increasingly concerned that women with heart attacks may be less likely to receive prompt and effective treatment. The difference between the sexes in the presentation of symptoms is thought to be a major barrier to better treatment for women. But now a study published in JAMA Internal Medicine finds that a key aspect of these differences — the description of chest pain in the emergency department — may not play as big a role as previously suspected.
European investigators analyzed data from nearly 2500 chest pain patients seen at nine hospitals in Switzerland, Spain, and Italy. Some 18% of the women and 22% of the men were ultimately found to have a myocardial infarction as determined by ECG and troponin tests. The investigators looked at the chest pain characteristics (CPCs) of the men and women in the study and examined whether these characteristics differed according to sex in their frequency or ability to improve the diagnosis of MI.
Most of the 34 characteristics they examined were reported by men and women with a similar frequency, though women were more likely to report several of the CPCs more often. This finding, write the authors, “extends and corroborates” previous studies. But, they note, the previous studies “were unable to address the key question whether attention to any of these CPCs would improve the early diagnosis of AMI in women.”
The investigators then found that most CPCs were not helpful in improving the diagnosis of MI. CPCs “are not powerful enough to be used as a single tool in the diagnosis of AMI and need to be used always in conjunction with the ECG and cTn test results,” they write.
Three CPCs were statistically significantly different between men and women in helping to predict MI, but these differences “did not seem clinically helpful,” say the authors. In addition, because they looked at so many different CPCs, the finding may well have been due to chance. The same pattern emerged when the investigators looks at different combinations of CPCs.
In an invited commentary, Louise Pilote writes that there has been considerable controversy over “whether men and women have fundamentally different presentations of AMI.” The new study “clarifies that presentation of chest pain between men and women is not as different as is commonly thought and provides new knowledge on the value and limitation of chest pain in making a diagnosis of AMI in women as well as in men.” She rejects the Men Are From Mars, Women Are From Venus premise and recommends an alternative view from George Carlin: “Men are from earth, women are from earth — deal with it!”