GENDER DIFFERENCES IN THE MANAGEMENT OF ACUTE CHEST PAIN - SUPPORT FOR THE YENTL-SYNDROME

OBJECTIVE: To determine whether evaluation and management of males and females differ after presentation to the emergency department with ac ute chest pain. DESIGN: Prospective cohort study with follow-up at 1 m onth. SETTING: Urban teaching hospital. PATIENTS: The study population included 1,411 patients who were 30 years of age or older who visited the emergency department with acute chest pain from October 1990 thro ugh May 1992. These 1,411 patients represent 69% of the 2,056 patients approached for consent. The utilization of exercise stress testing as outpatients was measured for a subset of 954 patients who were interv iewed at 1 month after their presentation. MEASUREMENTS/MAIN RESULTS: After controlling for clinical and nonclinical predictors, women were less likely to he admitted to the hospital (adjusted odds ratio [OR] 0 .68; 95% confidence interval [CI] 0.47, 0.99). Among the 954 patients with 1-month follow-up, women were less likely than men to undergo an exercise stress test during the first month after presentation, with b orderline statistical significance after adjusting for the interaction between Bender and admission to the hospital (adjusted OR 0.30; 95% C I 0.09, 1.0). Among the patients who were admitted to the hospital, wo men were as likely as men to undergo exercise stress testing (adjusted OR 0.81; 95% CI 0.57, 1.2) but were less likely to undergo cardiac ca theterization (adjusted OR 0.44; 95% CI 0.25, 0.80). CONCLUSIONS: Gend er-based differences in management may occur at several stages in the evaluation of patients with acute chest pain. Observed differences in use of invasive procedures between men and women may be due in part to lower rates of exercise test use and admission to the hospital for ev aluation of acute chest pain.