Department of Medicine, Center for Health Evaluation and Outcomes Science, University of British Columbia, Vancouver, British Columbia, Canada.
JAMA Intern Med. 2013 Nov 11;173(20):1863-71. doi: 10.1001/jamainternmed.2013.10149.
Little is known about whether sex differences in acute coronary syndrome (ACS) presentation exist in young patients and what factors determine absence of chest pain in ACS presentation.
To evaluate sex differences in ACS presentation and to estimate associations between sex, sociodemographic, gender identity, psychosocial and clinical factors, markers of coronary disease severity, and absence of chest pain in young patients with ACS.
DESIGN, SETTING, PARTICIPANTS: We conducted a prospective cohort study of 1015 patients (30% women) 55 years or younger, hospitalized for ACS and enrolled in the GENESIS PRAXY (Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome) study (January 2009-September 2012).
The McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey was administered during hospitalization.
The median age for both sexes was 49 years. Women were more likely to have non-ST-segment elevation myocardial infarction (37.5 vs 30.7; P = .03) and present without chest pain compared with men (19.0% vs 13.7%; P = .03). Patients without chest pain reported fewer symptoms overall and no discernable pattern of non-chest pain symptoms was found. In the multivariate model, being a woman (odds ratio [OR], 1.95 [95% CI, 1.23-3.11]; P = .005) and tachycardia (OR, 2.07 [95% CI, 1.20-3.56]; P = .009) were independently associated with ACS presentation without chest pain. Patients without chest pain did not differ significantly from those with chest pain in terms of ACS type, troponin level elevation, or coronary stenosis.
Chest pain was the most common ACS symptom in both sexes. Although women were more likely to present without chest pain than men, absence of chest pain was not associated with markers of coronary disease severity. Strategies that explicitly incorporate assessment of common non-chest pain symptoms need to be evaluated.
关于年轻患者中急性冠状动脉综合征 (ACS) 表现是否存在性别差异，以及哪些因素决定 ACS 表现中是否存在胸痛，目前知之甚少。
评估 ACS 表现中的性别差异，并估计性别、社会人口统计学、性别认同、心理社会和临床因素、冠状动脉疾病严重程度标志物以及年轻 ACS 患者胸痛缺失之间的关联。
设计、地点、参与者：我们对 1015 名年龄在 55 岁或以下、因 ACS 住院并参加 GENESIS PRAXY（性别和性决定因素对心血管疾病的影响：从基础到过早急性冠状动脉综合征）研究的患者（2009 年 1 月至 2012 年 9 月）进行了前瞻性队列研究。
在住院期间进行了 McSweeney 急性和前驱性心肌梗死症状调查。
两种性别的中位年龄均为 49 岁。与男性相比，女性更有可能患有非 ST 段抬高型心肌梗死（37.5%比 30.7%；P=.03）且无胸痛表现（19.0%比 13.7%；P=.03）。无胸痛的患者总体报告的症状较少，并且没有发现明显的非胸痛症状模式。在多变量模型中，女性（比值比 [OR]，1.95 [95%置信区间，1.23-3.11]；P=.005）和心动过速（OR，2.07 [95%置信区间，1.20-3.56]；P=.009）与 ACS 无胸痛表现独立相关。无胸痛的患者在 ACS 类型、肌钙蛋白水平升高或冠状动脉狭窄方面与有胸痛的患者没有显著差异。
胸痛是两种性别中最常见的 ACS 症状。尽管女性比男性更有可能无胸痛表现，但胸痛缺失与冠状动脉疾病严重程度标志物无关。需要评估明确纳入常见非胸痛症状评估的策略。
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