Background: Recognition of sex differences in symptom presentation of acute myocardial infarction (AMI) is important for timely clinical diagnosis. We sought to address two research questions in our review: do men and women equally present with chest pain as a symptom of AMI, and are there sex differences in other presenting symptoms of AMI.
Methods: A systematic review of research articles published between 1990 and 2009 was conducted using MEDLINE, CINAHL, EMBASE, Cochrane Library, Current Contents and ISI Web of Knowledge. A meta-analysis was performed and summary effect measures were calculated and expressed as odds ratios and risk ratios.
Results: Twenty-seven studies met the inclusion criteria. Meta-analysis showed women with AMI had 37% lower odds and a 7% lower rate of presenting with chest pain than men (OR = 0.63, 95% CI 0.59, 0.68; RR = 0.93, 95% CI 0.91, 0.95). Women were significantly more likely than men to present with fatigue, neck pain, syncope, nausea, right arm pain, dizziness and jaw pain. For most symptoms of AMI, adjusting for age and other variables made no significant difference to the magnitude of the effect.
Conclusions: Women are significantly less likely than men to experience chest pain and are much more likely than men to experience other associated symptoms of AMI. We recommend that public health campaigns on symptom presentation of AMI continue to promote chest pain as the cardinal symptom of AMI, but also reflect a wider spectrum of possible symptoms and highlight potential differences in symptom presentation between men and women.
© 2011 Published by Elsevier Inc.