Tuesday, January 21, 2020

Gender Differences in Symptom Presentation for STEMI


It is not new information that the male sex has been overly represented in medical research. From symptom presentation to the effect of different medications on the body, everything has been centered around men. As a consequence, women have silently suffered longer wait times to the Cath lab and being sent home with the diagnosis of anxiety for far too long. Finally, we have entered a time period where women have begun to be the center of research.

Recently, the International Journal of Cardiology published a study in Sweden titled “Gender differences in symptom presentation of ST-elevation myocardial infarction- An observational multicenter survey study.” This study was a multicenter observational study that focused on answering whether there are gender differences in symptom presentation in ST-elevation myocardial infarctions (STEMIs). Participants were enrolled within 24 hours after admission to reduce recall bias. Of the results collected, the most important finding was that there was a strong and independent association between female gender and non-chest pain presentation. In fact, the most common presentation was shoulder pain, as well as throat/neck pain. Women were also three times as likely to have associated nausea. 

These findings are important for several reasons. First off, while older studies have found gender differences in chest pain prevalence, more recent ones have shown no differences. What is important to note is that of the mentioned recent studies, none restricted the inclusion to STEMI patients, but had a mixed inclusion of acute coronary syndrome (ACS) patients. Studies have shown that in a mixed MI cohort, a higher percentage of women than men will have NSTE ACS, and the clinical presentation of STEMI and non-ST-elevation (NSTE) ACS has been found to differ with more severe symptoms in STEMI. Given these findings, it is imperative that more and larger studies are done to understand, acknowledge and spread awareness to symptom presentation in women to decrease the time it takes from initial symptom presentation to cath lab.

Nishita Saraiya  DUCOM 2020

 

Source:

Lawesson, S et al. (2018). Gender differences in symptom presentation of ST-elevation myocardial infarction- An observational multicenter survey study. International Journal of Cardiology, 264(4)7-11.