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Chest Pain Characteristics Don't Help Diagnose AMI in Women

Small differences in sex-specific diagnostic performance of chest pain characteristics
TUESDAY, Nov. 26, 2013 (HealthDay News) -- Small differences are observed in the sex-specific diagnostic performance of chest pain characteristics (CPCs) for diagnosing acute myocardial infarction (AMI), according to a study published online Nov. 25 in JAMA Internal Medicine.
In an effort to explore the role of sex-specific CPCs in the diagnosis of AMI, Maria Rubini Gimenez, M.D., from the University Hospital Basel in Switzerland, and colleagues conducted a prospective study involving 2,475 consecutive patients (796 women and 1,679 men) presenting with acute chest pain to nine emergency departments.
The researchers found that, in 18.0 percent of women and 22.0 percent of men, AMI was the adjudicated final diagnosis. Several CPCs were reported more frequently in women, although most were reported with similar frequency in men and women. For most CPCs, the accuracy for AMI was low in men and women, with likelihood ratios close to 1. The likelihood ratios were similar for the diagnosis of AMI in men and women in 91.2 percent of CPCs (31 of 34). Only three CPCs had a sex-specific diagnostic performance with P < 0.05 for the interaction, and they were related to pain duration (two to 30 minutes and more than 30 minutes) and dynamics (decreasing pain intensity). These three CPCs did not seem clinically helpful as their likelihood ratios were close to 1. Similar results were seen for CPC combinations.
"In conclusion, differences in the sex-specific diagnostic performance of CPCs overall are small," the authors write. "Our findings do not seem to support the use of CPCs specific to women in the early diagnosis of AMI in women."
Two authors disclosed financial ties to the pharmaceutical and diagnostic industries.
Abstract (http://archinte.jamanetwork.com/article.aspx?articleid=1783306#Abstract )Full Text (subscription or payment may be required) (http://archinte.jamanetwork.com/article.aspx?articleid=1783306 )Editorial (subscription or payment may be required) (http://archinte.jamanetwork.com/article.aspx?articleid=1783301 )
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