Abstract 9264: Predicting Acute Coronary Heart Disease Events in Women
Background: Coronary heart disease (CHD) is treatable if detected early yet few instruments measure women's prodromal symptoms (PS) of CHD. The McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS) identifies women's PS but prospective cohort data regarding the MAPMISS' predictability is limited.
Purpose: To conduct a longitudinal observational cohort study designed to assess the ability of the MAPMISS' PS score to predict CHD events requiring clinical intervention in women, and to identify the most predictive components of the MAPMISS' PS score.
Methods: Women referred for initial cardiac evaluation to clinics in Arkansas and Kentucky were eligible to participate; those with previous cardiac events and cognitive impairment were excluded. A total of 1114 women participated. The MAPMISS questionnaire was administered at time of enrollment and subsequently every 3 months for two years. The MAPMISS contains 33 PS. Each PS is weighted by its reported severity (0-3, 3=most severe) and frequency (less than monthly to daily, 0.125-7, 7=daily), and summed across symptoms (range 0-693). Cox proportional-hazards models adjusted by age and race were used to estimate hazard ratios (HR) and corresponding 95% confidence intervals (CI) for CHD events. Prodromal symptoms were entered in the Cox model as time dependent covariates.
Results: Of the 1114 women, 1097 (98.5%) completed the study. Of these, 77 (7%) reported having an adverse cardiac event during the two-year follow-up. The total PS score was a significant predictor of adverse cardiac events (p<0.001). Back pain, between/under shoulder blades, was the strongest predictor of adverse cardiac events (HR=3.17, 95%CI = 1.28- 7.85), followed by change in thinking or remembering (HR=2.90, 95%CI = 1.20- 7.04), and non-specific, generalized chest pain (HR=2.97, 95%CI = 1.04- 8.50). Women reporting one or more of these three symptoms were over 5 times as likely to have an adverse cardiac event as women with none of these symptoms (HR=5.25, 95%CI = 2.37- 11.64).
Conclusion: The total PS score from the MAPMISS could be useful in screening women at risk of an adverse cardiac event.
- © 2011 by American Heart Association, Inc.