Sex differences in the diagnostic evaluation of coronary artery disease

Division of Cardiology, Department of Medicine, Stanford University, Stanford, CA, USA.
Journal of Nuclear Cardiology (Impact Factor: 2.94). 02/2011; 18(1):144-52. DOI: 10.1007/s12350-010-9315-2
Source: PubMed


Although sex differences in coronary heart disease (CHD) have long been recognized, many of the recommendations for the management of female patients continue to be identical to male patients. Given the paucity of sex-specific data in basic science and clinical studies, however, defining unique diagnostic and therapeutic strategies for women remains problematic for scientists and clinicians. For instance, women represent only 38% of subjects in previously NIH-funded cardiovascular studies. 1 Previous studies and clinical trials have also included inadequate numbers of women. Finally, only 25% of previous cardiovascular clinical trials have reported sex-specific results. 2 Recently, researchers have been encouraged to report sex differences in basic and clinical studies. Much of the impetus originates from data indicating that more women die of cardiovascular disease (CVD) than men. 3 This disparity in mortality may signal the need for sex-specific guidelines for the diagnosis of CHD. In this review, we will discuss sex differences in the clinical manifestations and outcome of CHD, the limitations of current approaches for the management of female patients, and the potential strategies to improve the evaluation of CHD in women.

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Available from: Joseph C Wu, Feb 02, 2015
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    ABSTRACT: Abstract Background. Emergency management of myocardial infarction (MI) is time-critical, because improved patient outcomes are associated with reduced time from symptom onset to definitive care. Previous studies have identified that women are less likely to present with chest pain. Objective. We sought to measure the effect of sex on symptoms reported to the ambulance dispatch and ambulance times for MI patients. Methods. The Western Australia Emergency Department Information System (EDIS) was used to identify patients with emergency department (ED) diagnoses of MI (ST-segment elevation MI and non-ST-segment elevation MI) who arrived by ambulance between January 1, 2008, and October 31, 2009. Their emergency telephone calls to the ambulance service were transcribed to identify presenting symptoms. Ambulance data were used to examine ambulance times. Sex differences were analyzed using descriptive and age-adjusted regression analysis. Results. Of 3,329 MI patients who presented to Perth EDs, 2,100 (63.1%) arrived by ambulance. After predefined exclusions, 1,681 emergency calls were analyzed. The women (n = 621; 36.9%) were older than the men (p < 0.001) and, even after age adjustment, were less likely to report chest pain (odds ratio [OR] = 0.70; 95% confidence interval [CI] 0.57, 0.88). After age adjustment, ambulance times did not differ between the male and female patients with chest pain. The women with chest pain were less likely than the men with chest pain to be allocated a "priority 1" (lights and sirens) ambulance response (men 98.3% vs. women 95.5%; OR = 0.39; 95% CI 0.18, 0.87). Conclusion. Ambulance dispatch officers (and paramedics) need to be aware of potential sex differences in MI presentation in order to ensure appropriate ambulance response.
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