Acute Coronary Syndromes: Women are Stronger
Acute Coronary Syndromes: Women are Stronger
Abstract & Commentary
By Joseph E. Scherger, MD, MPH, Professor, University of California, San Diego. Dr. Scherger reports no financial relationship to this field of study.
Synopsis: Among men and women with an acute coronary syndrome without ST segment elevation, men are much more likely than women to develop an acute myocardial infarction.
Source: Svensson L, et al. Are predictors for myocardial infarction the same for women and men when evaluated prior to hospital admission? Int J Cardiol. 2006;109:241-247.
This prospective study from Sweden looked at 433 men and women presenting acutely with an acute coronary syndrome without ST elevation. Forty-five per cent of the patients were women. The average age of the men was 67 and of the women 73. Two thirds of the patients in both groups had a previous history of angina pectoris. The study looked at symptoms, clinical findings, ECG pattern and biochemical markers.
The clinical picture of acute coronary syndrome among men and women in this study was similar. Almost all the patients had chest pain and about half had dyspnea. Men were more likely than women to develop a cold sweat (35 to 26%). More women than men had nausea (33 to 26%). The most dramatic finding was that fewer women (17%) than men (26%) developed an acute myocardial infarction (AMI). Among the patients with ST segment depression (23% of men and 30% of women), the difference was more striking with 54% of men and only 22% of women developing an AMI.
Commentary
Coronary heart disease is the most common cause of death in women and men. Studies through the years have suggested that women may present differently with acute coronary syndromes than men, with whom the classic findings of angina and acute myocardial infarction have been described. Women have been suggested as more often having coronary spasm and chest pain which rules out as a myocardial infarction. Prior to hospital admission women appear to have a lower mortality than men.1,2 The opposite is found after hospital admission where women have a higher mortality especially in younger age groups.1,2 It has been reported that women are treated less aggressively than men which may be related to a different clinical picture.3,4
This large prospective study from Sweden looked at differences between men and women with acute coronary syndromes without initial evidence of an acute myocardial infarction by ST segment elevation. Men are more likely to develop a cold sweat, a more certain sign of acute coronary disease than nausea, which was more common in women. For whatever reasons, men are more likely than women to develop an AMI in this situation, especially if there is initial ST segment depression. Compared to men, women with acute coronary syndromes appear to be more resilient. Their clinical picture
is often more subtle. Traditional classic signs of angina appear more often in men than women. Hence women need a higher index of suspicion for acute coronary disease when they present acutely with chest pain in the emergency setting.
References
1. MacIntyre K, et al. Gender and survival: a population based study of 201,114 men and women following a first acute myocardial infarction. J Am Coll Cardiol. 2001;38:729-735.
2. Rosengren A, et al. Sex differences in survival after myocardial infarction in Sweden. Data from the Swedish National Acute Myocardial Infarction register. Eur Heart J. 2001;22:314-322.
3. Mahon NG, et al. Gender differences in the management and outcome of acute myocardial infarction in unselected patients in the thrombolytic era. Am J Cardiol. 2000;85:921-926.
4. Rathore SS, et al. Sex differences in cardiac catheterization after acute myocardial infarction: the role of procedure appropriateness. Ann Int Med. 2002;137:487-493.
Among men and women with an acute coronary syndrome without ST segment elevation, men are much more likely than women to develop an acute myocardial infarction.Subscribe Now for Access
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