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Sex and gender differences in symptoms of acute coronary syndromes Mackay, Martha Helen


Background: Better understanding of acute coronary syndrome (ACS) symptoms is needed to improve diagnosis. Prior research has suggested sex or gender differences in ACS symptoms, but these studies have been fraught with methodological issues. Using percutaneous coronary intervention (PCI), specifically angioplasty balloon inflation to model myocardial ischemia, this study examined whether sex or gender differences exist in reported symptoms of ACS, and other predictors of ACS symptoms. Methods: Consecutive patients having non-emergent PCI were prospectively recruited. Hemodynamic instability, left bundle branch block and total occlusion were exclusion criteria. Prior to PCI, descriptions of prior symptoms that had led to referral for PCI were obtained. Balloon inflation was sustained for two minutes unless a clinical reason to deflate occurred. During inflation, subjects were questioned about current symptoms. Concurrent ECG data were collected. Findings: Of the final sample of 305 (39.7% women; mean age 63.9 years (SD = 10.6), 245 (83%) had ECG-evident ischemia during inflation. No sex/gender differences were found in rates of reporting chest discomfort or “typical” symptoms, regardless of ischemic status. Women were significantly more likely to report throat, jaw and neck discomfort, as well as only non-chest discomfort. Controlling for age, diabetes, urgency of procedure, prior MI or prior PCI increased the sex/gender effect. Increased age, urgency, prior MI and PCI were also covariates with specific symptoms. Conclusions: This prospective study with ECG confirmation of ischemia suggests women and men have similar rates of chest discomfort and other “typical” symptoms during ACS. However women are more likely to experience throat, jaw and neck discomfort. Although other factors also influence reported symptoms, they do not diminish the effect of sex/gender. There has been suggestion in both the popular press and patient education materials that women experience ACS very differently from men. Therefore, it is important that clear educational messages be crafted to ensure both women and health professionals realise that classic symptoms of ACS are equally common in women and men.

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