Abstract 14194: Shortness of Breath Predicts Acute Coronary Syndrome in Women Only
Introduction: Patients presenting to the emergency department (ED) with chest pain and/or associated symptoms suggestive of acute coronary syndromes (ACS) present a diagnostic conundrum. We hypothesized that the sensitivity, specificity, and predictive value of symptoms for a diagnosis of ACS (STEMI, NSTEMI & unstable angina) would vary by gender.
Methods: Patients admitted to four EDs with symptoms suggestive of ACS were enrolled. The 13-item validated ACS Symptom Checklist was used to assess symptoms as they were occurring on presentation to the ED. Mixed effect logistic regression models were used to estimate sensitivity and sensitivity of each symptom as well as odds ratios of each symptom as a predictor of ACS. Analyses of symptoms were stratified by gender and the interaction of symptom by gender was tested.
Results: The sample (n = 688) included 276 patients ruled-in and 412 ruled-out for ACS. Patients were predominantly male (62%), Caucasian (69%), and with a mean age of 59±14 years. Chest discomfort, pressure, and pain demonstrated the highest sensitivity for ACS in both women and men. Shortness of breath was also sensitive for women. Six symptoms were specific for a non-ACS diagnosis and nausea was specific for men only (Table). Shoulder pain (OR=2.41, 95% CI 1.25-4.66) and arm pain (OR=2.23, 95% CI 1.14-4.33) were significant predictors of ACS in women and chest pain (OR=1.8, 95% CI 1.08-2.99) and absence of shortness of breath (OR=0.49, 95% CI 0.29-0.77) were significant predictors of ACS in men after adjusting for age, obesity, functional status, and diabetes mellitus. Only shortness of breath was significant when testing the interaction effect of each symptom by gender (p=0.011).
Conclusions: There were more similarities than differences in symptom predictors of ACS between women and men. Shortness of breath was sensitive in women only and may be the key additional symptom that improves clinical prediction of ACS in this population.
- © 2013 by American Heart Association, Inc.