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Sex-Specific Chest Pain Characteristics in AMI

Sex-Specific Chest Pain Characteristics in AMI. Jay Mansfield, Pgy -3 July 22 , 2014. LSU Journal Club. Gimenez , M, et. Al. Jama Int Med. 2014;174(2):241-249. November 2013. Background. Symptoms concerning for acute myocardial infarction accounts fo r ~10% of all ED visits

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Sex-Specific Chest Pain Characteristics in AMI

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  1. Sex-Specific Chest Pain Characteristics in AMI Jay Mansfield, Pgy-3 July 22, 2014 LSU Journal Club Gimenez, M, et. Al. JamaInt Med. 2014;174(2):241-249. November 2013.

  2. Background • Symptoms concerning for acute myocardial infarction accounts for ~10% of all ED visits • 90% have a chief complaint of chest pain/discomfort • Of these, only ~10-20% have an actual AMI • Our tools for diagnosis include medical history/risk factors, EKGs, cardiac troponin assay and chest pain characteristics (CPCs)

  3. Background • Sex-specific differences have been observed to detriement women • Delayed diagnosis, misdiagnosis, higher AMI mortality rate, and possibly less benefit from early PCI • Large amounts of data have shown that women with AMI may differ from men with AMI, so…..

  4. Research question • Can we use sex-specific CPCs to differentiate women with AMI from those with non-cardiac CP, and how do they relate to men with certain CPCs? • Answering this question can aid us in more accurate and timely use of medical therapy in women and men with AMI

  5. Study design • Organized by Advantageous Predictors of Acute Coronary Sydrome Evaluation (APACE) • Prospective trial aimed at diagnosis in early AMI • Nine different centers in Europe, last from 2006-2012 • Each case was reviewed using conventional cardiac troponin assay (cTn) followed by a second high-sensitivity cTn (hs-cTn) • AMI was defined as cTn >99th percentile or cTn >10% over imprecision value if not 99th percentile • This had to be in conjunction with clinical picture • All recordes were also reviewed independently by 3 separate cardiologists 90-days after the episode

  6. Study Subjects • Inclusion criteria • Men and women with age >18 with chest pain or discomfort that had onset or peaked within 12 hours of presentation • Exclusion criteria • Anyone with ESRD on regular HD • 2475 patients included – 32% women, 68% men • AMI found in 143 women and 369 men

  7. Chest Pain Characteristics • Quality • Aggravating, alleviating factors • Localization, size • Radiation • Onset, duration, dynamics • Prior episodes • Severity 34 Total

  8. Results

  9. Only 3 CPCs were significantly different • Pain 2-30 minutes and decreasing pain lower risk for AMI in women • Duration > 30 minutes increased risk in men

  10. Conclusions • 1) Although most presentations are similar between men and women 11/34 CPCs are sex-specific • 2) Most assessed CPCs did not differentiate AMI from other causes of CP in women or men • 3) Differences in sex-specific diagnostic performances of CPCs are overall small

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