年轻心肌梗死患者症状表现和感知的性别差异：VIRGO 研究的证据（恢复的变化：性别对年轻 AMI 患者结局的影响）。
Sex Differences in the Presentation and Perception of Symptoms Among Young Patients With Myocardial Infarction: Evidence from the VIRGO Study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients).
机构信息
Department of Chronic Disease Epidemiology (J.H.L., E.C.L.)
Yale School of Public Health, New Haven, CT. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (J.H.L., H.B., H.M.K., N.P.L.).
出版信息
Circulation. 2018 Feb 20;137(8):781-790. doi: 10.1161/CIRCULATIONAHA.117.031650.
BACKGROUND
Some studies report that women are less likely to present with chest pain for acute myocardial infarction (AMI). Information on symptom presentation, perception of symptoms, and care-seeking behaviors is limited for young patients with AMI.
METHODS
We interviewed 2009 women and 976 men aged 18 to 55 years hospitalized for AMI at 103 US hospitals participating in the VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients). Structured patient interviews during the index AMI hospitalization were used to collect information on symptom presentation, perception of symptoms, and care-seeking behaviors. We compared patient characteristics and presentation information by sex. Multivariable hierarchical logistic regression was used to evaluate the association between sex and symptom presentation.
RESULTS
The majority of women (87.0%) and men (89.5%) presented with chest pain (defined as pain, pressure, tightness, or discomfort). Women were more likely to present with ≥3 associated symptoms than men (eg, epigastric symptoms, palpitations, and pain or discomfort in the jaw, neck, arms, or between the shoulder blades; 61.9% for women versus 54.8% for men, <0.001). In adjusted analyses, women with an ST-segment-elevation AMI were more likely than men to present without chest pain (odds ratio, 1.51; 95% confidence interval, 1.03-2.22). In comparison with men, women were more likely to perceive symptoms as stress/anxiety (20.9% versus 11.8%, <0.001) but less likely to attribute symptoms to muscle pain (15.4% versus 21.2%, =0.029). Approximately 29.5% of women and 22.1% of men sought medical care for similar symptoms before their hospitalization (<0.001); however, 53% of women reported that their provider did not think these symptoms were heart-related in comparison with 37% of men (<0.001).
CONCLUSIONS
The presentation of AMI symptoms was similar for young women and men, with chest pain as the predominant symptom for both sexes. Women presented with a greater number of additional non-chest pain symptoms regardless of the presence of chest pain, and both women and their healthcare providers were less likely to attribute their prodromal symptoms to heart disease in comparison with men.
背景
一些研究报告显示，女性发生急性心肌梗死（AMI）时出现胸痛的可能性较小。对于年轻的 AMI 患者，有关症状表现、对症状的感知以及寻求医疗护理的行为的信息有限。
方法
我们对在美国 103 家医院参与 VIRGO 研究（年轻 AMI 患者中性别对结局的影响：康复的差异）的 2009 名女性和 976 名年龄在 18 至 55 岁之间的因 AMI 住院的男性进行了访谈。在 AMI 住院期间进行了结构化的患者访谈，以收集有关症状表现、对症状的感知和寻求医疗护理行为的信息。我们按性别比较了患者特征和表现信息。采用多变量层次逻辑回归评估了性别与症状表现之间的关联。
结果
大多数女性（87.0%）和男性（89.5%）表现为胸痛（定义为疼痛、压迫感、紧绷感或不适）。与男性相比，女性更有可能出现≥3 种相关症状，例如上腹部症状、心悸以及下巴、颈部、手臂或两肩之间的疼痛或不适（61.9%的女性比 54.8%的男性，<0.001）。在调整后的分析中，与男性相比，ST 段抬高型 AMI 女性出现无胸痛表现的可能性更高（比值比，1.51；95%置信区间，1.03-2.22）。与男性相比，女性更可能将症状感知为压力/焦虑（20.9%比 11.8%，<0.001），但不太可能将症状归因于肌肉疼痛（15.4%比 21.2%，=0.029）。与男性相比，约 29.5%的女性和 22.1%的男性在住院前因类似症状寻求过医疗护理（<0.001）；然而，与 37%的男性相比，53%的女性报告称其医生认为这些症状与心脏病无关（<0.001）。
结论
年轻女性和男性 AMI 症状的表现相似，胸痛是两性的主要症状。无论是否存在胸痛，女性出现的其他非胸痛症状数量都较多，且女性及其医护人员不太可能将前驱症状归因于心脏病，而男性则更有可能这样做。
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