Abstract 10047: A Prospective Cohort Evaluation of the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey to Examine Short Term Cardiac Events in Women

Abstract

INTRODUCTION: Few instruments measure women’s prodromal symptoms (PS) of CHD. While the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS) identifies women’s PS, it has only been evaluated previously in retrospective studies.

OBJECTIVE: To evaluate the usefulness of the MAPMISS in identifying women who would have a cardiac event or intervention (stent, angioplasty, CABG, MI or ACS) within three months, using data from a prospective cohort study.

METHODS: Women referred to cardiology for initial evaluation of CHD at 15 clinics were eligible for participation. Other inclusion criteria included: Caucasian or African American, >21 years, cognitively intact, no previous CHD diagnosis, and access to a telephone. After consenting by telephone, a cognitive screen was administered followed by the MAPMISS PS section (33 symptoms, plus risk factors and demographic variables). Odds ratios and corresponding 95% confidence intervals for the association between PS and confirmed cardiac events were computed using logistic regression and adjusting for personal characteristics and risk factors. Predictive utility was evaluated for MAPMISS PS individually and in combination. The most predictive set of PS was used to construct parsimonious models.

RESULTS: 1097 women completed the MAPMISS survey; 51 (4.7%) had a cardiac event/intervention within three months. Women with events were older, had lower SES, and had more chronic conditions than women without events. Of the 33 PS, 11 were significantly associated with the occurrence of a cardiac event. Women with events were almost 3 times as likely to report arm discomfort/pain, 2.5 times as likely to have pain in the jaw/teeth, and over 2 times as likely to complain of severe fatigue as women not experiencing an event. The parsimonious model retained arm pain (OR=2.51; 95% CI=1.36, 4.61) and fatigue (OR=2.04; 95% CI=1.03, 4.02) as the most predictive PS. Women reporting one or both symptoms were over twice as likely to have an event as those reporting neither symptom (OR=2.24; 95% CI=1.10, 4.58).

CONCLUSION: The MAPMISS is useful in screening women for risk of experiencing a CHD event within 3 months.