The Influence of Gender on Symptom Characteristics During Acute Coronary Syndrome

摘要 预计超过140万美国人将经历一场急性肺炎 2010年的冠脉综合征(ACS)。急性冠脉综合征的症状评估很重要 因为症状决定了患者何时或是否寻求治疗。最近的研究表明 确定了急性冠脉综合征症状的性别差异，然而，回顾设计， 从医疗记录中提取症状，以及评估表格的变化 使得很难确定性别差异的临床意义，或者性别 特定的健康信息是有保证的。因此，这项前瞻性研究的目的是 是为了：1)评估13个人的发生、严重程度和痛苦的性别差异 调整了年龄、诊断、合并症和功能状态后的ACS症状，2) 确定症状的敏感度、特异度和预测值作为 适用于女性和男性的ACS，3)探索症状群，包括以下特征 性别、年龄、诊断、合并症和功能状态，以及4)决定是否有 功能障碍的纵向结局(30天和6个月)是否存在性别差异 状况，重大心血管事件，入院，急诊科就诊， 和死亡率。探索性的目标是确定 为女性和男性选择的急性冠脉综合征的生物标志物和症状。一种新的方法，在 哪些症状在急诊科出现时会被记录下来？ 被利用。样本将包括630名急诊患者。 有急性冠脉综合征症状的科室：522例确诊的急性冠脉综合征患者和 108例患者排除了急性冠脉综合征。参与者将从年内的四个医疗中心招募 伊利诺斯州和俄勒冈州。13项急性冠脉综合征症状检查表将于 向急诊科做报告。合并症、活动状态和患者 当患者病情稳定时，将对变量进行测量。试点数据表明， 手术是可行和安全的。将使用协方差分析来检验 在症状上存在性别差异的假设。症状群将是 使用聚集聚类分析进行检查，并将评估患者的结果 使用线性混合方法。研究结果将有助于确定其临床意义。 急性冠脉综合征症状。

Abstract More than 1.4 million Americans are expected to experience an episode of acute coronary syndromes (ACS) in 2010. Evaluation of the symptoms of ACS is important since symptoms determine when, or if, patients seek care. Recent studies have identified gender differences in symptoms of ACS, however retrospective designs, abstraction of symptoms from medical records, and variations in assessment forms make it difficult to determine the clinical significance of gender differences or if gender specific health messages are warranted. Therefore, the aims of this prospective study are to: 1) evaluate for gender differences in the occurrence, severity, and distress of 13 ACS symptoms after adjusting for age, diagnosis, comorbidities, and functional status, 2) establish the sensitivity, specificity, and predictive value of symptoms as an indicator of ACS for women and men, 3) explore symptom clusters including characteristics of gender, age, diagnosis, comorbidities, and functional status, and 4) determine if there are gender differences in the longitudinal (30 days and 6 months) outcomes of functional status, major cardiovascular events, hospital admissions, emergency department visits, and mortality. An exploratory aim is to determine if a relationship exists between selected biomarkers and symptoms of ACS for women and men. A novel approach, in which symptoms are recorded in the emergency department as they are occurring, will be used. The sample will be comprised of 630 patients admitted to the emergency department with symptoms suggestive of ACS: 522 patients with confirmed ACS and 108 patients ruled out for ACS. Participants will be recruited from four medical centers in Illinois and Oregon. The 13-item ACS Symptom Checklist will be completed on presentation to the emergency department. Comorbidities, activity status, and patient variables will be measured when the patient is stable. Pilot data indicate that the procedures are feasible and safe. Analysis of covariance will be used to test the hypothesis that there are gender differences in symptoms. Symptom clusters will be examined using agglomerative cluster analysis, and patient outcomes will be evaluated using linear mixed methods. Findings will aid in establishing the clinical significance of ACS symptoms.