Relations of Sex to Diagnosis and Outcomes in Acute Coronary Syndrome

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Abstract
Background: The atypical presentation of women with acute coronary syndrome ( ACS ) has been related to delayed diagnosis and treatment, which may explain worse outcome compared with men. Methods and Results: We analyzed pooled data of 2520 patients of 2 prospective cohorts in terms of differences in presentation and management of women and men suggestive of ACS . Using logistic regression, we established 2 diagnostic models and tested their diagnostic performance in both sexes separately. Sex‐specific differences in management of patients with ACS were ascertained and a 2‐year follow‐up was performed. Women were older than men (median 67 versus 61 years, P =0.001), had more often dyspnea (22% versus 18%, P =0.024), nausea or vomiting (26% versus 16%, P =0.001) and radiating chest pain (47% versus 40%, P =0.001). Classical risk factors (smoking, diabetes mellitus, dyslipidemia or known coronary artery disease) were less frequent in women. Diagnostic models showed no significant sex‐related differences in diagnostic performance in a “first contact” setting (medical history and symptoms) or after “complete triage” (including ECG and biomarkers). Women with ACS underwent coronary angiography (73.8% versus 84.3%, P P <0.001) less frequently. Two‐year incidence of myocardial infarction and death was similar in both sexes, but revascularization and cardiac rehospitalization were more frequent in men. Conclusions: In a large cohort of patients with suspected ACS , sex differences in clinical presentation did not impair diagnostic accuracy. Two‐year outcomes were comparable. Our findings suggest a benefit of chest pain units to minimize sex differences in ACS management and prognosis. Clinical Trial Registration: URL : https://www.clinicaltrials.gov . Unique identifiers: NCT 02355457 ( BACC ), NCT 03227159 (stenoCardia).

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