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Meta-Analysis
. 2020 May 5;9(9):e014733.
doi: 10.1161/JAHA.119.014733. Epub 2020 May 4.

Sex Differences in Symptom Presentation in Acute Coronary Syndromes: A Systematic Review and Meta-analysis

Roos E M van Oosterhout  1 , Annemarijn R de Boer  1   2 , Angela H E M Maas  3 , Frans H Rutten  1 , Michiel L Bots  1 , Sanne A E Peters  1   4
Affiliations
Meta-Analysis

Sex Differences in Symptom Presentation in Acute Coronary Syndromes: A Systematic Review and Meta-analysis

Roos E M van Oosterhout et al. J Am Heart Assoc. .

Abstract

Background Timely recognition of patients with acute coronary syndromes (ACS) is important for successful treatment. Previous research has suggested that women with ACS present with different symptoms compared with men. This review assessed the extent of sex differences in symptom presentation in patients with confirmed ACS. Methods and Results A systematic literature search was conducted in PubMed, Embase, and Cochrane up to June 2019. Two reviewers independently screened title-abstracts and full-texts according to predefined inclusion and exclusion criteria. Methodological quality was assessed using the Newcastle-Ottawa Scale. Pooled odds ratios (OR) with 95% CI of a symptom being present were calculated using aggregated and cumulative meta-analyses as well as sex-specific pooled prevalences for each symptom. Twenty-seven studies were included. Compared with men, women with ACS had higher odds of presenting with pain between the shoulder blades (OR 2.15; 95% CI, 1.95-2.37), nausea or vomiting (OR 1.64; 95% CI, 1.48-1.82) and shortness of breath (OR 1.34; 95% CI, 1.21-1.48). Women had lower odds of presenting with chest pain (OR 0.70; 95% CI, 0.63-0.78) and diaphoresis (OR 0.84; 95% CI, 0.76-0.94). Both sexes presented most often with chest pain (pooled prevalences, men 79%; 95% CI, 72-85, pooled prevalences, women 74%; 95% CI, 72-85). Other symptoms also showed substantial overlap in prevalence. The presence of sex differences has been established since the early 2000s. Newer studies did not materially change cumulative findings. Conclusions Women with ACS do have different symptoms at presentation than men with ACS, but there is also considerable overlap. Since these differences have been shown for years, symptoms should no longer be labeled as "atypical" or "typical."

Keywords: acute coronary syndrome; diagnosis; meta‐analysis; sex differences; symptoms; systematic review.

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Figures

Figure 1
Figure 1
Flow diagram of search results and study selection.
Figure 2
Figure 2
Pooled crude and adjusted odds ratios of symptoms experienced by women relative to men. OR indicates odds ratio.
Figure 3
Figure 3
Results of the aggregated and cumulative meta‐analysis for chest pain as a symptom of ACS in women relative to men summarized in a forest plot. ACS indicates acute coronary syndromes; OR indicates odds ratio.
Figure 4
Figure 4
Results of the meta‐analysis of the pooled prevalence and corresponding 95% CI for all symptoms for ACS in women and men. ACS indicates acute coronary syndromes.
See this image and copyright information in PMC

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