Article Text

other Versions

PDF
Gender, race and the presentation of acute coronary syndrome and serious cardiopulmonary diagnoses in ED patients with chest pain
  1. Ahmed Allabban1,2,
  2. Judd E Hollander3,
  3. Jesse M Pines4
  1. 1Department of Emergency Medicine, George Washington University, Washington, District of Columbia, USA
  2. 2Department of Emergency Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
  3. 3Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  4. 4Departments of Emergency Medicine and Health Policy & Management, George Washington University, Washington, District of Columbia, USA
  1. Correspondence to Dr Jesse M Pines, Jesse M Pines, MD, 2100 Pennsylvania Avenue, N.W. Room 314, Washington, DC 20037, USA; Pinesj{at}gwu.edu

Abstract

Objective To assess the relationship between reported chest pain symptoms and a diagnosis of acute coronary syndrome (ACS) and serious cardiopulmonary diagnoses (SCPD) in black males, white males, black females and white females.

Methods This was a secondary analysis of a prospective cohort study of 4162 ED patients with chest pain enrolled between 1999 and 2008. We used logistic regression, adjusting for age and cardiovascular comorbidities to test the association between 24 chest pain symptoms and 30-day ACS for the primary outcome and SCPD as the secondary outcome.

Result In black males, diaphoresis was associated with ACS (OR 1.47; 95% CI 1.02 to 2.13), while in white males, left arm radiation, pressure/tightness and substernal pain were associated with ACS (OR 1.73, 95% CI 1.16 to 2.59; OR 1.65, 95% CI 1.16 to 2.59; OR 1.51, 95% CI 1.07 to 2.11, respectively). In black females, diaphoresis, palpitations and left arm radiation were associated with ACS (OR 1.66, 95% CI 1.17 to 2.35; 1.66, 95% CI 1.13 to 2.45; 1.44, 95% CI 1.02 to 2.03, respectively) while pleuritic pain, and left anterior chest pain lowered ACS risk (OR 0.69, 95% CI 0.5 to 0.96; 0.54, 95% CI 0.35 to 0.84). No symptoms predicted ACS or SCPD in white females. Fewer but similar symptoms predicted SCPD in white males and black females. No symptoms predicted SCPD in black males.

Conclusion Chest pain symptoms are important predictors of ACS and SCPD in certain combinations of race and gender but less so in others. These differences might explain difficulties using symptoms to identify patients at higher or lower risk of ACS and SCPD in practice.

  • Chest pain
  • Race
  • Gender
  • Presentation
  • Outcomes
  • Acute coronary syndrome

Statistics from Altmetric.com

Footnotes

  • Twitter @DrJessePines

  • Contributors AA: study concept and design; analysis and interpretation of the data; drafting of the manuscript; and statistical expertise. JEH: acquisition of the data; analysis and interpretation of the data; and critical revision of the manuscript for important intellectual content. JMP: study concept and design; acquisition of the data; critical revision of the manuscript for important intellectual content; and study supervision.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.