Sex differences in patient-reported symptoms associated with myocardial infarction (from the population-based MONICA/KORA Myocardial Infarction Registry).
Level 3 - non-randomized controlled study
Observational population-based registry cohort study with multivariable adjustment
PubMed 21420056 · doi:10.1016/j.amjcard.2011.01.040
What was done
Standardized patient interviews were used to record the occurrence of 13 acute myocardial infarction symptoms in 2,278 patients (568 women and 1,710 men) aged 25 to 74 years hospitalized with a first-ever acute myocardial infarction from 2001 to 2006 in the population-based MONICA/KORA registry. Multivariable logistic regression was performed to evaluate sex differences, controlling for age, migration status, body mass index, smoking, comorbidities including diabetes, and infarct type and location.
What was found
No significant sex differences were observed for chest pain, feelings of pressure or tightness, diaphoresis, pain in the right shoulder/arm/hand, or syncope. Women had significantly higher odds of reporting pain between the shoulder blades (OR 2.22, 95% CI 1.78 to 2.77), vomiting (OR 2.23, 95% CI 1.67 to 2.97), fear of death (OR 2.17, 95% CI 1.73 to 2.72), nausea (OR 1.94, 95% CI 1.56 to 2.39), throat/jaw pain (OR 1.78, 95% CI 1.43 to 2.21), dizziness (OR 1.49, 95% CI 1.16 to 1.91), dyspnea (OR 1.45, 95% CI 1.17 to 1.78), upper abdominal pain (OR 1.39, 95% CI 1.02 to 1.91), and left shoulder/arm/hand pain (OR 1.36, 95% CI 1.10 to 1.69). Women were also significantly more likely to report more than 4 symptoms (OR 2.14, 95% CI 1.72 to 2.66).
Why it matters
This study demonstrates that women present with typical chest symptoms at rates equivalent to men but experience a greater overall symptom burden and more accompanying radiation and autonomic symptoms. Recognizing this presentation pattern can help prevent diagnostic delays in female myocardial infarction patients.
Limits
The study was restricted to hospitalized patients aged 25 to 74 years with a first myocardial infarction, excluding out-of-hospital deaths and older adults. Symptom assessment relied on post-event interviews, introducing potential recall bias.
Cited by
- supports During heart attacks, chest and arm pain are less common in women than in men, while shortness of breath is more common in women.