Objective: To identify differences in the incidences of myocardial infarction in women and men with chest pain.
Design: Prospective multicenter cohort study.
Setting: Emergency rooms of three university and four community bospitals.
Patients: 7,734 emergency room patients with acute chest pain.
Measurements and main results: Myocardial infarction was diagnosed in 10% of the 3,896 women, compared with 19% of the 3,838 men, yielding an age-adjusted
relative risk of myocardial infarction for women of 0.54 (95% confidence interval 0.48, 0.60). Physicians were equally adept
at admitting women and men with myocardial infarctions, but men without myocardial infarction or unstable angina were significantly
more likely to be admitted than were women without these diagnoses. Most clinical and electrocardiographic features indicating
a risk of myocardial infarction were present in both women and men, but several high-risk features were less commonly present
in women. After adjusting for the other factors that correlate with each patient’s probability of having acute myocardial
infarction, the relative risk of myocardial infarction was the same in women as men when the emergency department electrocardiogram
showed the classic changes associated with acute myocardial infarction, but the risk was 40% lower in women when such electrocardiographic
changes were not present.
Conclusions: Clinical features that predict myocardial infarction in men predict myocardial infarction in women to a similar extent. However,
female gender is associated with about a 40% lower rate of myocardial infarction except when classic electrocardiographic
evidence is present on the emergency department electrocardiogram.
Key words myocardial infarction - gender profile - acute chest pain - emergency room
Received from the Divisions of Clinical Epidemiology and General Medicine and the Cardiovascular Division, Department of Medicine,
Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; Yale—New Haven Hospital and Yale University
School of Medicine, New Haven, Connecticut; and the University of Cincinnati Hospital and University of Cincinnati, Cincinnati,
Ohio.
Supported in part by grant No. 83102-2H from the John A. Hartford Foundation, New York, New York. Dr. Cunningham was an Andrew
W. Mellon Foundation Fellow in Clinical Epidemiology. Dr. Lee is the recipient of a Public Health Service Clinical Investigator
Award (HL01594-01) from the National Heart, Lung, and Blood Institute. Dr. Rouan is a Teaching and Research Scholar of the
American College of Physicians and was supported in part by a grant to the Training Program in Clinical Effectiveness from
the W.K. Kellogg Foundation.
The Multicenter Chest Pain Study Group includes Lee Goldman, MD (co-principal investigator), Thomas H. Lee, MD, E. Francis
Cook, ScD, Monica Weisberg, RN, Karen Daley, RN, and Barbara C. Rosen, BA (Brigham and Women’s Hospital, Boston, Massachusetts;
George Terranova, MD (site director), Carol Stasiulewicz, PA, and David Copen, MD (Danbury Hospital, Danbury, Connecticut;
Alan Brandt, MD (site director), and Jay Walshon, MD (Milford Hospital, Milford, Connecticut); Louis Gottlieb, MD (site director),
(St. Mary’s Hospital, Waterbury, Connecticut); Gregory Rouan, MD (site director), Jerris R. Hedges, MD, Robert Toltzis, MD,
and Beth Goldstein-Wayne, RN (University of Cincinnati Hospital), Cincinnati, Ohio); Michael Kobernick, MD (site director),
Carolyn Guidot, MD, and Daniel Jones, MPH (William Beaumont Hospital, Royal Oak, Michigan); and Donald A. Brand, PhD (co-principal
investigator), Denise Acampora, MPH, John Mellors, MD, Kathryn Trainor, MS, Rita M. Jakubowski, RN, and Sue Healy, RN (Yale—New
Haven Hospital, New Haven, Connecticut).