PRESENTATIONS OF ACUTE MYOCARDIAL-INFARCTION IN MEN AND WOMEN

OBJECTIVE: To assess the influence of gender on the likelihood of acut e myocardial infarction (AMI] among emergency department (ED) patients with symptoms suggestive of acute cardiac ischemia, and to determine whether any specific presenting signs or symptoms are associated more strongly with AMI in women than in men. DESIGN: Analysis of cohort dat a from a prospective clinical trial. SETTING: Emergency departments of 10 hospitals of varying sizes and types in the United States. PATIENT S: Patients 30 years of age or older (n = 10.525) who presented to the ED with chest pain or other symptoms suggestive of acute cardiac isch emia. MEASUREMENTS AND MAIN RESULTS: The prevalence of AIM was determi ned for men and women, and a multivariable logistic regression model p redicting AMI was developed to adjust for patients' demographic and cl inical characteristics. AMI was almost twice as common in men as in wo men (10% vs 6%). Controlling for demographics, presenting signs and sy mptoms, electrocardiogram features, and hospital, male gender was a si gnificant predictor of AMI (odds ratio [OR] 1.7; 95% confidence interv al [CI] 1.4, 2.0). The gender effect was eliminated, however, among pa tients with ST-segment elevations on electrocardiogram (OR 1.1: 95% CI 0.7, 1.7) and among patients with signs of congestive heart failure ( CHF) (OR 1.1; 95% CI 0.8, 1.5). Signs of CHF were associated with AMI among women (OR 1.9; 95% CI 1.4, 2.6] but not men (OR 1.0; 95% CI 0.8, 1.3). Among patients who presented to EDs with chest pain or other sy mptoms suggestive of acute cardiac ischemia, AMI was more likely in me n than in women. Among women with ST-segment elevation or signs of CHF , however, AMI likelihood was similar to that in men with these charac teristics.