ED Diagnosis of Acute Coronary Syndromes: No Gender-Related Difference of \u27Chest Discomfort\u27

Background: There is evidence of gender and diabetes-related differences in symptoms of ACS upon presentation to the ED: i.e., non-diabetic men typically report ‘chest pain’, whereas women and diabetics may report atypical complaints such as arm or jaw pain, nausea, etc. This may reflect differences in either ACS-related chest pain, or differences between men vs. women in the perceptionof pain. Objective:Our aim was to obtain insight into this issue by comparing the frequency of broadly defined, ‘chest-associated discomfort’ rather than ‘chest pain’ reported by men vs. women and diabetics vs. non-diabetics with MI. Methods:This is a prospective, ongoing, IRB-approved study enrolling patients presenting to an urban academic medical center with the subsequent diagnosis of NSTEMI/STEMI. After admission patients were interviewed using a focused, semi-structured format and queried as to the presence (yes/no), severity, and quality of chest discomfort–defined as any symptom referred to the thorax–upon ED presentation. Severity was scored on a scale of 1 to 10; the quality was categorized as: pressure or tightness; burning or ‘heartburn’; sharp or shooting sensation; cramping; or other. Patients were excluded if unstable or otherwise unable to give a history. Incidence of discomfort was compared in women vs. men by Fisher’s exact test, while severity was compared by t-test. Results:Interim analysis of the 81 patients enrolled to date reveals no significant gender-related differences in either the incidence (91% in females versus 94% in males: p=0.69) or severity of chest discomfort (mean score of 7.4±2.8 in females versus 7.2±2.4 in males; p=0.76). Also no significant diabetes-related difference in either the incidence (86% in diabetics vs. 95% in non-diabetics, p=0.18) or severity (6.8±2.9 in diabetics vs. 7.4±2.4 in non-diabetics, p=0.34) of chest discomfort was found. Conclusion:These preliminary results suggest that, while there may be gender or diabetes-related differences in the perception of ‘chest pain’, there is an equivalent incidence and severity of ‘chest discomfort’ in all groups. This re-enforces the importance of pursuing broad complaints of chest discomfort in the ED