1. Kayyali, Andrea


According to this study:


* The characteristics of chest pain in men and women with acute myocardial infarction (AMI) were similar. However, chest pain characteristics alone weren't helpful for early detection of AMI in women.



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In a new prospective study, researchers investigated whether certain chest pain characteristics (CPCs) in women could help to differentiate an acute myocardial infarction (AMI) from other conditions involving chest pain.


From April 2006 until August 2012, researchers enrolled 2,475 subjects (796 women and 1,679 men) who presented with AMI-like symptoms, including chest pain, at nine different EDs in Spain, Italy, and Switzerland. Thirty-four types of CPCs were used to describe the patient's pain, such as its location and quality, where it radiated, and which factors or agents relieved it (such as nitroglycerin). The researchers then compared the CPCs in all of the women against those in patients with a confirmed AMI diagnosis and against those in their male counterparts.


Most of the men's and women's CPCs were similar at baseline. Some of the differences in women's CPCs were more frequent reports of pressure-like pain, attendant dyspnea, and pain radiating to the throat or back. Women less frequently reported right-sided radiation and a pain duration of two to 30 minutes (as opposed to less than two minutes or longer than 30 minutes).


Acute MI was diagnosed in 18% of the women (n = 143) and 22% of the men (n = 369). In the AMI group, five of the 34 CPCs significantly differed between men and women: women less often reported radiation to the right arm or shoulder, decreasing pain, or pain lasting two to 30 minutes; women more often reported back radiation and chest pain lasting longer than 30 minutes.


Only three CPCs differed enough between men and women to reach statistical significance: when women reported chest pain lasting between two and 30 minutes or reported decreasing pain, their chances of having an AMI were lower, and when women's pain lasted longer than 30 minutes, their chances of having an AMI were higher. However, wide confidence intervals and likelihood ratios close to 1 lessened the clinical significance of the differences.


The researchers concluded that consideration of CPCs specific to women was not helpful in distinguishing AMI from other causes of chest pain and advised considering CPCs along with other diagnostics (electrocardiography and cardiac troponin levels) to make an accurate diagnosis.




Rubini Gimenez M, et al. JAMA Intern Med 2013 Nov 25 [Epub ahead of print].