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22-02-2012 | Cardiology | Article

Women less likely to have chest pain, more likely to die after heart attack


Free abstract

MedWire News: Women experiencing myocardial infarction (MI) are more likely to present without chest pain and to die than men of the same age, a study shows.

However, these differences are attenuated with increasing age, report John Canto (Watson Clinic and Lakeland Regional Medical Center, Florida, USA) and colleagues in JAMA.

It is important to target high-risk groups, ie, young women as soon as possible with information on the symptoms of a heart attack, they add.

The study analyzed data on symptom presentation and in-hospital mortality of 1,143,513 patients from the National Registry of Myocardial Infarction between 1994 and 2006.

The findings revealed that the proportion of MI patients who presented without chest pain was significantly higher in women than men, at 42.0% versus 30.7% (p<0.001).

There was a significant association between age and gender with chest pain at presentation, with a larger gender difference in younger than older patients, which became attenuated with advancing age.

Indeed, women younger than 45 years were 30% more likely than men of the same age to present without chest pain, those aged 45-4 years 26% more likely, those aged 55-64 years 24% more likely, those aged 65-74 years 13% more likely, and those aged 75 years or older only 0.03% more likely. The two-way interaction between gender and age on MI presentation without chest pain was significant (p<0.001).

The in-hospital mortality rate was 14.6% for women and 10.3% for men. In fully adjusted models, younger women presenting without chest pain or discomfort had greater in-hospital mortality rates than men, a trend that reversed with increasing age.

Women younger than 45 years who presented without chest pain had an 18% increased risk for mortality, those aged 45-54 years a 13% increased risk, and those aged 55-64 years a 0.02% increased risk. However, women aged 65-74 years who presented without chest pain had a 0.09% decreased risk for mortality, and those aged 75 or over a 19% decreased risk.

The three-way interaction between gender, age, and chest pain with mortality was significant (p<0.001).

"These data suggest that the absence of chest pain may be a more important predictor of death in younger women with MI compared with other similarly aged groups," the authors write.

They suggest that because women are generally older than men when presenting for MI, at 73.9 versus 66.5 years, this could be related to whether they present with chest pain, as well as subsequent hospital mortality.

Canto and team conclude that more qualitative and quantitative research is necessary to fully ascertain acute MI symptoms in men and women of different ages, as well as the role of these symptoms in patients' care-seeking practices and clinical outcomes.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Piriya Mahendra

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