Abstract 15260: Prodromal Symptoms for Acute Coronary Syndrome in Men and Women
Introduction: Prodromal symptoms occur prior to acute coronary syndrome (ACS) and may provide an opportunity for early intervention. We determined the frequency of prodromal symptoms, treatment seeking behaviour for such symptoms and association of treatment seeking with ACS type (STEMI, NSTEMI or unstable angina), coronary stenosis and mortality risk score (GRACE).
Methods: A prospective cohort study of 1096 patients (30% women) aged ≤55 years, hospitalized for ACS in the GENESIS PRAXY (GENdEr and Sex DetermInantS of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary SYndrome) study (Jan/09-Sept/12). The validated McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey was used during hospitalization to assess the presence and intensity of 33 prodromal symptoms prior to ACS symptom onset. Prodromal symptoms were defined as at least moderate intensity and occurring ≥ 1 time/week. Patients completed questionnaires on treatment seeking. ACS type, coronary stenosis and GRACE scores were obtained from chart review and angiographic data (conducted in 90%).
Results: The median age of women and men was 49 years, 51% of women and 63% of men had STEMI. Women reported prodromal symptoms more often than men (85% vs. 73%, p<0.001). Symptoms were similar for both sexes, and most commonly included tiredness, sleepiness, anxiety, arm weakness or arm pain. Prodromal chest pain was reported in 23% of patients. Women and men sought medical care for their prodromal symptoms (49% vs. 42%, p=0.05) and most (91%) received testing, medication changes, or referral to a specialist and/or hospital with that care. Men who sought care were less likely to present with STEMI (50% vs. 68%, p<0.0001) compared with men who did not seek care. Women who sought care presented less often with STEMI or NSTEMI than unstable angina (84% vs. 94%, p=0.006). There were no differences in coronary stenosis or GRACE mortality score.
Conclusion: While prodromal symptoms occurred frequently in young men and women, less than half sought medical care for these symptoms. Having sought care was associated with less severe ACS types at presentation. Public awareness of prodromal symptoms may provide an opportunity to identify patients at risk for impending ACS.
- © 2013 by American Heart Association, Inc.