Do MI Women Commonly Present with Atypical Symptoms? Not really, according to a prospective study in Scotland. The study included 1941 patients (39% women) with suspected acute coronary syndrome. Standardized criteria defined typical and atypical presentations based on pain nature, location, radiation, and additional symptoms. Diagnosis of myocardial infarction (MI) was adjudicated using a high‐sensitivity cardiac troponin I assay with sex‐specific thresholds (>16 ng/L women, >34 ng/L men). Patients identified who were missed by the contemporary assay with a uniform threshold (≥50 ng/L) were reclassified by this approach. Type 1 MI was diagnosed in 16% of men and 12% of women, with 5% men and 30% women reclassified using high‐sensitivity cardiac troponin I and sex‐specific thresholds. Chest pain was the presenting symptom in 91% of men and 92% of women. Typical symptoms were more common in women than in men with MI (77% versus 59%), and differences were similar in those reclassified (74% versus 44%). The presence of ≥3 typical features was associated with a positive likelihood ratio for the diagnosis of MI in women (positive likelihood ratio, 1.18) but not in men (positive likelihood ratio 1.09). The findings suggest that both men and women with acute coronary syndrome present with an array of symptoms and should not be assessed differently. Source: https://www.ahajournals.org/
