ArticleBMJ open2018
Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study.
Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it, 56 citations in OpenAlex.
- Pooled it
- Gender disparities in coronary artery disease: a review of factors influencing clinical outcomes.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2025Review
- Patient-Reported Symptoms of Acute Coronary Syndrome in the Prehospital Period in a Prospective Study: Implications for Emergency Nurse Triage, Diagnosis, and Clinical Outcomes.Journal of emergency nursing · 2025Article
- Gender-stratified analyses of symptoms associated with life-threatening events in patients calling out-of-hours primary care for shortness of breath.BMC primary care · 2025Article
- Sex differences in outcomes in patients with acute myocardial infarction.BMC cardiovascular disorders · 2025Article
- Hypertriglyceridemia as an independent predictor of adverse prognosis in female patients with acute myocardial infarction: a comprehensive retrospective cohort study.Frontiers in nutrition · 2025Article
- Symptomology, Outcomes and Risk Factors of Acute Coronary Syndrome Presentations without Cardiac Chest Pain: A Scoping Review.European cardiology · 2024Article
- Sex Disparities in Diagnostic Evaluation and Revascularization in Patients With Acute Myocardial Infarction-A 15-Year Nationwide Study.Journal of the American Heart Association · 2023Article
- Clinical presentation in EMS patients with acute chest pain in relation to sex, age and medical history: prospective cohort study.BMJ open · 2022Observational
- Construction of a femininity score in the UK Biobank and its association with angina diagnosis prior to myocardial infarction.Scientific reports · 2022Article
- Sex and Age Differences in Patient-Reported Acute Stroke Symptoms.Frontiers in neurology · 2022Article
- Gender-differences in antithrombotic therapy across the spectrum of ischemic heart disease: Time to tackle the Yentl syndrome?Frontiers in cardiovascular medicine · 2022Review
- Gender-stratified analyses of symptoms associated with acute coronary syndrome in telephone triage: a cross-sectional study.BMJ open · 2021Article
- Evaluating Sex Disparities in the Emergency Department Management of Patients With Suspected Acute Coronary Syndrome.Annals of emergency medicine · 2021Article
- Gender-Related Differences in Chest Pain Syndromes in the Frontiers in CV Medicine Special Issue: Sex & Gender in CV Medicine.Frontiers in cardiovascular medicine · 2021Review
- Diagnostic and Management Dilemmas in Women Presenting with Acute Coronary Syndromes.Current cardiology reports · 2020Review
- Relationship between the Severity of Coronary Artery Disease and Cardiovascular Risk Factors in Acute Coronary Syndrome: Based on Tehran Heart Center's Data Registry.The journal of Tehran Heart Center · 2020Article
- Typical and Atypical Symptoms of Acute Coronary Syndrome: Time to Retire the Terms?Journal of the American Heart Association · 2020Article
- Factors Associated with Prehospital Delay among Men and Women Newly Experiencing Acute Coronary Syndrome: A Qualitative Inquiry.Cardiology research and practice · 2020Article
- Gender in cardiovascular medicine: chest pain and coronary artery disease.European heart journal · 2019Review
Corrections and comments
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Authors and funding
10 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesPrompt diagnosis of acute coronary syndrome (ACS) remains a challenge, with presenting symptoms affecting the diagnosis algorithm and, consequently, management and outcomes. This study aimed to identify sex differences in presenting symptoms of ACS.
designData were collected within a prospective cohort study (EPIHeart).
settingPatients with confirmed diagnosis of type 1 (primary spontaneous) ACS who were consecutively admitted to the Cardiology Department of two tertiary hospitals in Portugal between August 2013 and December 2014.
participantsPresenting symptoms of 873 patients (227 women) were obtained through a face-to-face interview. OUTCOME MEASURES: Typical pain was defined according to the definition of cardiology societies. Clusters of symptoms other than pain were identified by latent class analysis. Logistic regression was used to quantify differences in presentation of ACS symptoms by sex.
resultsChest pain was reported by 82% of patients, with no differences in frequency or location between sexes. Women were more likely to feel pain with an intensity higher than 8/10 and this association was stronger for patients aged under 65 years (interaction P=0.028). Referred pain was also more likely in women, particularly pain referred to typical and atypical locations simultaneously. The multiple symptoms cluster, which was characterised by a high probability of presenting with all symptoms, was almost fourfold more prevalent in women (3.92, 95% CI 2.21 to 6.98). Presentation with this cluster was associated with a higher 30-day mortality rate adjusted for the GRACE V.2.0 risk score (4.9% vs 0.9% for the two other clusters, P<0.001).
conclusionsWhile there are no significant differences in the frequency or location of pain between sexes, women are more likely to feel pain of higher intensity and to present with referred pain and symptoms other than pain. Knowledge of these ACS presentation profiles is important for health policy decisions and clinical practice.
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