Symptoms Suggestive of Acute Coronary Syndrome When Is Sex Important?
Symptoms Suggestive of Acute Coronary Syndrome When Is Sex Important?
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DOI：
10.1097/jcn.0000000000000351
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发表时间：
2017-07-01
影响因子：
2
通讯作者：
Rosenfeld, Anne G.
中科院分区：
文献类型：
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作者：
DeVon, Holli A.;Burke, Larisa A.;Rosenfeld, Anne G.
背景资料：研究已经确定了急性冠状动脉综合征（ACS）症状的性别差异;然而，回顾性设计、从病历中提取症状以及评估表格的变化使得难以确定性别差异的临床意义。目的：本研究的目的是确定性别对13种症状的发生和痛苦的影响，这些症状提示ACS的急诊科患者。方法：共有1064例患者入住5个急诊科的症状触发心脏评估。测量人口统计学和临床变量、症状、共病情况和功能状态。结果：样本主要为男性（n = 664，62.4%）、白色（n = 739，69.5%）和已婚（n = 497，46.9%）。女性年龄明显大于男性（61.3 +/- 14.6 vs 59.5 +/- 13.6岁）。大多数患者出院时诊断为非ACS（n = 590，55.5%）。ACS女性患者较少报告胸痛为主诉，而更多报告恶心（比值比[OR]，1.56;置信区间[CI]，1.00-2.42）、肩痛（OR，1.76; CI，1.13-2.73）和上背痛（OR，2.92; CI，1.81-4.70）。ACS女性患者的症状多于男性患者（6.1 vs 5.5; P = 0.026）。与女性相比，无ACS的男性症状困扰较少。结论：女性和男性评估ACS报告胸痛的发生率相似，但在其他典型症状上存在差异。这些发现表明，女性和男性应被告知ACS并不总是伴随着胸痛，多种症状可能同时发生。
Background: Studies have identified sex differences in symptoms of acute coronary syndrome (ACS); however, retrospective designs, abstraction of symptoms from medical records, and variations in assessment forms make it difficult to determine the clinical significance of sex differences. Objective: The aim of this study is to determine the influence of sex on the occurrence and distress of 13 symptoms for patients presenting to the emergency department for symptoms suggestive of ACS. Methods: A total of 1064 patients admitted to 5 emergency departments with symptoms triggering a cardiac evaluation were enrolled. Demographic and clinical variables, symptoms, comorbid conditions, and functional status were measured. Results: The sample was predominantly male (n = 664, 62.4%), white (n = 739, 69.5%), and married (n = 497, 46.9%). Women were significantly older than men (61.3 +/- 14.6 vs 59.5 +/- 13.6 years). Most patients were discharged with a non-ACS diagnosis (n = 590, 55.5%). Women with ACS were less likely to report chest pain as their chief complaint and to report more nausea (odds ratio[OR], 1.56; confidence interval[CI], 1.00-2.42), shoulder pain (OR, 1.76; CI, 1.13-2.73), and upper back pain (OR, 2.92; CI, 1.81-4.70). Women with ACS experienced more symptoms (6.1 vs 5.5; P = .026) compared with men. Men without ACS had less symptom distress compared with women. Conclusions: Women and men evaluated for ACS reported similar rates of chest pain but differed on other classic symptoms. These findings suggest that women and men should be counseled that ACS is not always accompanied by chest pain and multiple symptoms may occur simultaneously.