Department of Cardiology, University Hospital Basel, Basel, Switzerland2Servicio de Urgencias y Pneumologia, Ciber de Enfermedades Raras, Carles III Institute for Health, Hospital del Mar-Institut Municipal d'Investigació Mèdica, Barcelona, Spain.
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
JAMA Intern Med. 2014 Feb 1;174(2):241-9. doi: 10.1001/jamainternmed.2013.12199.
Whether sex-specific chest pain characteristics (CPCs) would allow physicians in the emergency department to differentiate women with acute myocardial infarction (AMI) from women with other causes of acute chest pain more accurately remains unknown. OBJECTIVE To improve the management of suspected AMI in women by exploring sex-specific CPCs.
DESIGN, SETTING, AND PARTICIPANTS: From April 21, 2006, through August 12, 2012, we enrolled 2475 consecutive patients (796 women and 1679 men) presenting with acute chest pain to 9 emergency departments in a prospective multicenter study. The final diagnosis of AMI was adjudicated by 2 independent cardiologists.
Treatment of AMI in the emergency department.
Sex-specific diagnostic performance of 34 predefined and uniformly recorded CPCs in the early diagnosis of AMI.
Acute myocardial infarction was the adjudicated final diagnosis in 143 women (18.0%) and 369 men (22.0%). Although most CPCs were reported with similar frequency in women and men, several CPCs were reported more frequently in women (P < .05). The accuracy of most CPCs in the diagnosis of AMI was low in women and men, with likelihood ratios close to 1. Thirty-one of 34 CPCs (91.2%) showed similar likelihood ratios for the diagnosis of AMI in women and men, and only 3 CPCs (8.8%) seemed to have a sex-specific diagnostic performance with P < .05 for interaction. These CPCs were related to pain duration (2-30 and >30 minutes) and dynamics (decreasing pain intensity). However, because their likelihood ratios were close to 1, the 3 CPCs did not seem clinically helpful. Similar results were obtained when examining combinations of CPCs (all interactions, P ≥ .05).
Differences in the sex-specific diagnostic performance of CPCs are small and do not seem to support the use of women-specific CPCs in the early diagnosis of AMI. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00470587.
在急诊科，是否存在特定于性别的胸痛特征（CPC）可以帮助医生更准确地区分急性心肌梗死（AMI）女性与其他急性胸痛原因女性，目前仍不清楚。目的：通过探索特定于性别的 CPC，改善疑似 AMI 女性的管理。
设计、地点和参与者：2006 年 4 月 21 日至 2012 年 8 月 12 日，我们前瞻性纳入了 2475 名连续就诊于 9 家急诊科的急性胸痛患者（796 名女性和 1679 名男性）。两名独立的心脏病专家通过裁定来诊断 AMI 的最终诊断。
急诊科 AMI 的治疗。
34 项预先确定和统一记录的 CPC 在早期诊断 AMI 中的性别特异性诊断性能。
143 名女性（18.0%）和 369 名男性（22.0%）被裁定为 AMI 的最终诊断。尽管大多数 CPC 在女性和男性中的报告频率相似，但一些 CPC 在女性中的报告频率更高（P <.05）。大多数 CPC 在女性和男性中诊断 AMI 的准确性都较低，似然比接近 1。34 项 CPC 中有 31 项（91.2%）对女性和男性的 AMI 诊断具有相似的似然比，只有 3 项 CPC（8.8%）似乎具有性别特异性诊断性能，交互作用 P <.05。这些 CPC 与疼痛持续时间（2-30 分钟和 >30 分钟）和动态变化（疼痛强度降低）有关。然而，由于它们的似然比接近 1，因此这 3 项 CPC 似乎在临床上没有帮助。当检查 CPC 组合时，也得到了类似的结果（所有交互作用，P ≥.05）。
CPC 特定于性别的诊断性能差异较小，似乎不支持在 AMI 的早期诊断中使用女性特异性 CPC。
clinicaltrials.gov 标识符：NCT00470587。
