Observational studyThe American journal of emergency medicine2026
Sex differences in acute chest pain care in a multisite U.S. emergency department cohort.
Observational study in The American journal of emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLarge studies examining sex-based differences in emergency department (ED) cardiovascular care are lacking. This analysis compared cardiovascular healthcare utilization and safety outcomes between women and men in a large U.S. cohort managed under a standardized high-sensitivity troponin (hs-cTn) pathway.
methodsWe conducted an observational study of ED patients ≥18 years old presenting with chest pain from 1/2021-12/2021 across 25 EDs. Sex was defined by the legal sex EHR variable. The primary safety outcome was 30-day all-cause death or myocardial infarction (MI). The primary healthcare utilization outcome was hospitalizations at 30 days. Secondary healthcare utilization outcomes included 30-day objective cardiac testing (OCT: stress testing, coronary computed tomography angiography, invasive coronary angiography). Outcomes were compared between sexes using chi-squared tests and logistic regression, where models adjusted for cardiovascular disease confounders and initial hs-cTn.
resultsAmong 40,979 patients, 56.6% (23,188/40,979) were female with mean age 52. Death or MI at 30 days occurred in 2.4% (552/23,188) of women and 5.2% (917/17,791) of men (p < 0.001). After adjustment, women had lower odds of death or MI (aOR 0.65, 95% CI 0.57-0.74). Hospitalizations occurred in 30.2% (6998/23,188) of women compared to 36.0% (6411/17,791) of men (p < 0.001). OCT occurred in 14.9% (3452/23,188) of women and 19.6% (3488/17,791) of men (p < 0.001). With adjustment, women were hospitalized less (aOR 0.93, 95% CI 0.88-0.98) and underwent less OCT (aOR 0.93, 95% CI 0.87-0.98) at 30-days.
conclusionIn a large ED cohort of patients with chest pain, rates of death or MI, hospitalizations, and OCT at 30-days were lower in women compared to men.
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