Type of Pain Not Helpful in Diagnosing MI in Women

New research finds that evaluating the characteristics of chest pain is not especially useful for the early diagnosis of acute myocardial infarction (MI) in women. Researchers from University Hospital Basel in Switzerland conducted a prospective, multicenter study of more than 2,400 patients, which that looked at 34 sex-specific chest pain characteristics, with only 3 of the characteristics (8.8 percent), all related to pain duration and dynamics, showing a sex-specific diagnostic performance. The authors looked at patients enrolled in the APACE trial, an ongoing study at centers in Italy, Spain, and Switzerland. From 2006 to 2012, male and female participants presented to the emergency department with symptoms that suggested acute MI, with symptom onset or peak occurring within the previous 12 hours. Men constituted about 68 percent of the study population, with a median age of 59, compared to age 70 for women. A greater number of men, 28.2 percent, had previously experienced an acute myocardial infarction, versus 15.1 of women. In addition, 32.9 percent of men had experienced revascularization, in comparison to 17.3 percent of women. Investigators found the accuracy of all chest pain characteristics—such as pain location and radiation, size of the pain area, pain quality, and aggravating or inducing factors, for example—for an acute MI diagnosis was low among men and women with likelihood ratios close to 1, which led researchers to state that most of the chest pain characteristics did not differentiate acute MI from other causes of acute chest pain. The final adjudicated diagnosis of acute MI was made in 18 percent of women and 22 percent of men. The authors noted that more than 90 percent of the chest pain characteristics turned in similar likelihood ratios for acute MI diagnosis in both sexes, with most of them not discriminating between MI and author causes of chest pain. The study’s aim was to “improve the assessment and management of women with chest discomfort at emergency departments,” says Maria Rubini-Gimenez, MD, a cardiologist at University Hospital Basel, and lead author of the study. “What we found out,” says Rubini-Gimenez, “is that, although there are important differences in symptoms experienced by women and men during a heart attack, focusing on women-specific symptoms does not seem to improve the early detection of a heart attack in women.” As such, Rubini-Gimenez advises primary care practitioners to “be extremely careful when assessing women who present with symptoms possibly suggestive of a heart attack.” As symptoms have only low-to-moderate accuracy, it is “mandatory to always add two additional, simple diagnosis tests—the electrocardiogram and a blood test for cardiac troponin—in order not to miss women with a heart attack,” she adds. The findings originally appeared online in the November 25, 2013 edition of JAMA Internal Medicine. —Mark McGraw Reference Rubini Gimenez M, Reiter M, et al. Sex-Specific Chest Pain Characteristics in the Early Diagnosis of Acute Myocardial Infarction. JAMA Internal Medicine. 2013.