[Chest pain in women: a multicenter study of the National Association of Hospital Cardiologists (ANMCO) of the Lazio Region]

Abstract

Background: Chest pain is an extremely common symptom in women, but several previous studies have suggested that in women this complaint is more frequently underdiagnosed than in men. The aim of this multicenter study proposed by the National Association of Hospital Cardiologists (ANMCO) was to analyze the clinical regimen adopted for women admitted to a public hospital of the Lazio Region for chest pain during a short period of time (only 30 days).

Methods: Between March 1 and March 31, 2001, 747 women were admitted in the Emergency Department of 20 public hospitals in the Lazio Region for chest pain. The patients' age ranged between 40 to 80 years (mean age 61.4 +/- 12.6 years). An ECG was recorded in 727 (97.5%), 326 (44%) underwent cardiologic examination, blood analysis was performed for 584 (78%) and 66 (8.8%) were submitted to two-dimensional echocardiography.

Results: Of the 727 ECGs, 403 (56%) were defined as "normal" by a cardiologist and 324 (44%) "abnormal". Of the 747 women with chest pain, 446 (60%) were discharged from the Emergency Department; 2 died (0.2%), and 298 (40%) were hospitalized. Among the latter, 169 (56%) were submitted to echocardiography, 45 (16%) to the ECG effort test, 22 (6%) to stress echocardiography, 40 (11%) to coronary angiography (3 also to primary coronary angioplasty), 10 (3.3%) to esophagogas-troduodenoscopy, and 68 (23%) to several non-cardiologic exams. The final diagnosis was atypical chest pain in 336 (45%), acute myocardial infarction in 60 (6.7%), paroxysmal atrial fibrillation in 42 (5.6%), typical angina in 60 (10.6%), aortic dissection in 3 (0.4%), pericarditis in 7 (0.9%), hypertensive crisis in 80 (11%), gastritis in 27 (3.6%), anxiety in 15 (2%), and a surgical or orthopedic diagnosis in 107 (14%). Two patients (0.2%) died. During follow-up (6 months) cardiac events occurred in 7.6% of 446 women discharged from the Emergency Department.

Conclusions: This study demonstrated that the diagnostic tests are underutilized in women with chest pain, even compared to previous studies including male and female subjects. For women presenting with chest pain, the use of non-invasive tests with the best prognostic impact should be increased.