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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

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.


  • 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)


  • 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…..

Research question
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

Study design
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

Study subjects
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

Chest pain characteristics
Chest Pain Characteristics

  • Quality

  • Aggravating, alleviating factors

  • Localization, size

  • Radiation

  • Onset, duration, dynamics

  • Prior episodes

  • Severity

34 Total

Sex specific chest pain characteristics in ami


  • 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