Abstract 13157: Acute Coronary Syndrome without Chest Pain in Young Adults

Abstract

Background: Women with acute coronary syndrome (ACS) are more likely to present without chest pain compared to men, but underlying reasons for atypical presentation remain unclear. We evaluated sociodemographic, gender role, psychosocial, clinical and anatomic factors potentially associated with atypical presentation in women and men.

Methods: Data were from GENESIS PRAXY (GENdEr and Sex DetermInantS of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary SYndrome), a study cohort of young (≤55y) patients hospitalized for ACS in 26 sites in Canada, US, and Switzerland. Atypical presentation was defined as absence of chest pain or chest pain of low intensity. Sex-specific multiple logistic regressions were estimated to assess the independent association of gender role, ethnicity, SES, menopausal status, diabetes, hypertension, depression, anxiety, ACS type, troponin level, and extent of coronary disease with atypical presentation.

Results: Of the 857 patients (mean age 48 years), more women than men did not report chest pain (20.9% vs. 14%, p<0.01). There was no significant difference in STEMI (44.9% vs. 51.4%), triple vessel disease (26.5% vs. 27%) or troponin rise >3^rd tertile (21% vs. 30.4%) in women with or without chest pain. Men without chest pain had a lower proportion of STEMI (55.2% vs. 67%, p=0.03) and troponin rise (24.7% vs. 37.7%, p=0.03) compared to men with chest pain. Predictors found to be independently associated with atypical presentation included higher household income (OR: 4.17, 95%CI: 1.6-10, p=0.003) and left main disease (OR: 4.4, 95%CI: 1.19-13.16, p=0.02) in women and higher education level (OR: 1.33, 95%CI: 1.02-3.06, p=0.04) in men.

Conclusion: Commonly considered factors including gender role, ACS type and psychological symptoms do not appear to be associated with atypical presentation. Young men without chest pain have less STEMI and lower troponin rise, but this was explained by differences in clinical and sociodemographic factors. Young women without chest pain still experience similar types of ACS and troponin rise compared to their chest pain counterparts. However, absence of chest pain in women may signal significant left main coronary disease.