Abstract 3794: Impact of Gender and Prodromes on Outcome in Acute Coronary Syndromes: A Population-Level Analysis
Background: We determined the rates at which acute coronary syndrome (ACS) patients seek medical attention for non-specific prodromal symptoms, as well as whether sex differences and an association between prodromes and one-year mortality exists.
Methods: All ACS patients in Alberta, Canada between July 2003 – December 2005 were included. Prodromes evaluated <90 days prior to ACS at physician, clinic and ED visits were:
pain (chest, arm, shoulder, neck, jaw, throat, or leg);
head-related (dizziness, headache, visual disturbances); and
other (sweating, shortness of breath, heart racing, cough, numbness).
Results: Of 14,226 (9000 men, 5226 women) ACS pts, 2123 (14.9%) sought medical attention for prodromes (17.6% women, 13.4% men, p<0.01). Women presented with anxiety/fatigue or head-related complaints, while men had pain-related symptoms. Seeking medical attention for prodromes was associated with improved survival in women (p=0.01) but not men (p=0.09). The interaction between gender and prodromes was significant (p=0.03) in a multivariable model, suggesting a differential impact of prodromal symptoms on mortality.
Conclusions: In this large contemporary and comprehensive ACS cohort only a small proportion of patients sought medical attention for prodromes prior to ACS. This behavior was associated with improved survival in women but not men. Further study to determine whether this benefit relates to initiation of cardiac investigation, or to less treatment delay is warranted.