Among patients with myocardial infarction, women are more likely than men to present to a hospital without chest pain and also have a higher rate of in-hospital death following MI than men within the same age group, although these differences decrease with increasing age, according to a study.
In background information for the study, which appears in the Feb. 22/29 issue of JAMA, the authors wrote: “Optimal recognition and timely management of myocardial infarction, especially for reducing patient delay in seeking acute medical care, is critical.”
Despite the acceptance of chest pain/discomfort as the hallmark symptom of MI, previous analyses have shown that a large number of patients with MI lack chest pain/discomfort at presentation. “Furthermore, patients without chest pain/discomfort tend to present later, are treated less aggressively and have almost twice the short-term mortality compared with those presenting with more typical symptoms of MI,” the authors wrote.
The researchers added that women are generally older than men at hospitalization for MI. “It is plausible that women’s older age at presentation is related to whether they present with chest pain, as well as subsequent hospital mortality.
“However, a limited number of studies have taken age into account in examining sex differences in MI clinical presentation.”
John G. Canto, MD, MSPH, of the Watson Clinic and Lakeland Regional Medical Center, in Lakeland, Fla., and colleagues examined the relationship between sex, symptoms when presenting to the hospital and the risk of death while in the hospital, before and after accounting for age in patients hospitalized with MI.
The study consisted of an analysis of data from the National Registry of Myocardial Infarction, 1994-2006, of 1,143,513 registry patients. Of these, 42.1% were women. Women with MI were significantly older than men at hospital presentation, with an average age of 74 vs. 67 for men.
The overall proportion of MI patients who presented without chest pain/discomfort was 35.4% and was significantly higher for women than men (42% vs. 30.7%). Age-specific and further analyses indicated a significant interaction between age and sex, with sex-specific differences in MI presentation without chest discomfort becoming progressively smaller with advancing age.
The in-hospital mortality rate was 14.6% for women and 10.3% for men. The researchers found that in the fully adjusted models, younger women presenting without chest pain/discomfort had greater hospital case-fatality rates than men, a trend that reversed with increasing age.
“However, younger women presenting with chest pain/discomfort had a greater hospital case-fatality rate than men with chest pain/discomfort in the same age group, but differences in hospital death rates between men and women decreased with advancing age” and was no longer significant in the oldest group, the authors wrote.
“These data suggest that the absence of chest pain may be a more important predictor of death in younger women with MI compared with other similarly aged groups.”
The authors said further research is needed to improve the current understanding of underlying pathophysiology. They said consideration is needed about whether to relay sex-tailored health messages to the general public and healthcare providers to encourage men and women with signs and symptoms of acute coronary syndromes to seek care promptly, which would result in improvement in the care and survival of women.
“Our results of sex-based differences in MI symptom presentation in younger patients are provocative and should be confirmed by others with clinical databases of MI or acute coronary syndromes,” the authors wrote.
“From a public health perspective, it is appropriate to target high-risk groups for delay (young women) with information on the American Heart Association/National Institutes of Health [MI] message, but until additional research is conducted, the current chest pain/discomfort [MI] symptom message, which targets women and men equally irrespective of age, should remain unchanged.”
To read a study summary and access the study via subscription or purchase, visit http://bit.ly/A5i3ew.