Symptom Presentation of Women With Acute Coronary Syndromes: Myth vs Reality
Topic: General Cardiology
Date Posted: 12/17/2007
急性冠脉综合症女性患者的症状介绍：神话VS 现实
话题：心脏病
发表日期：2007.12.17
Study Question: Do presenting symptoms of acute coronary syndrome (ACS) differ between men and women?
Methods: MEDLINE literature searches (1970-2005), and review of bibliographies and pertinent abstracts were used to identify studies, which collected data on presenting symptoms in men and women hospitalized for an ACS event. Of the 362 studies reviewed, 69 were included. Studies were included if symptom presentation was related to ACS (stable angina and chronic angina-related studies were excluded). Studies that lacked data on gender were also excluded. These studies were divided into two groups: large cohorts or registries, and smaller single-center studies or direct patient interviews.
课题研究：急性冠脉综合症男性患者和女性患者的症状不同吗？
方法：1975-2005年的MEDLINE文献调查中，回顾了一些确定下来的研究科目和相关摘要，回顾的362个研究中有69个研究报告收集了关于ACS男性患者和女性患者当前症状及住院治疗的数据资料，但是不包括有关稳定心绞痛和慢性心绞痛的研究。这些研究分成了两个组，一个是以集体研究注册，一个是单个个体研究注册。
Results: Approximately one-third of patients included in the large cohorts presented without chest pain or discomfort, whereas one-quarter of patients included in smaller studies had an ACS presentation without chest pain or discomfort. Women presented more often without chest pain or discomfort compared with men in the large cohort studies (37% vs. 27%) and in the smaller studies (30% vs. 17%). Women were more likely to have greater numbers of associated symptoms such as neck pain, shortness of breath, nausea or vomiting, weakness, or fatigue. Approximately one-quarter of ACS patients presented with silent or unrecognized myocardial infarction (MI), with no gender differences observed (27% for men vs. 26% for women). In data from both the National Registry of Myocardial Infarction-2 (NRMI-2) and the Framingham Heart Study, increasing age was more strongly associated with ACS presenting without chest pain than was female gender. However, among younger subjects in NRMI-2, the younger women were more likely to present without chest pain (or discomfort) compared with the younger men, which was not observed among older subjects.
结果：在大规模注册群体中，约有三分之一的病人没有胸痛或不适感，但在小规模注册的群体中有四分之一的病人患有ACS但没有胸痛或不适的迹象。在较大的群体中，对于以上提到的这种现象，女性患者与男性患者的比例为37% vs. 27%，在小群体中，女性患者与男性患者的比例为30% vs. 17%。相对而言，女性患者更可能发生一下症状诸如颈痛，呼吸短促，恶心。约有四分之一的ACS患者呈沉默状态或不是MI的状态，据观察在男性患者和女性患者之间并没有什么大体不同，比例为27% vs 26%。从NRMI-2和Framingham Heart Study得到的数字中发现，年龄增加与ACS患者没有胸痛迹象相吻合。但在NRMI-2新的研究课题上，年轻女性患者与年轻男性患者相比，更可能出现没有胸痛或不适现象。

Conclusions: The authors concluded that women presenting with ACS are less likely to report chest pain or discomfort compared to men with ACS. However, several limitations exist and thus no significant gender-related symptomatology criteria exist for identification of ACS.
Perspective: The authors point out several important limitations, as does the accompanying editorial, including the lack of standardized data collection, retrospective medical chart review, and patient-related recall bias. Despite all of these potential limitations, this review provides a thorough discussion on an important topic. This review highlights the oversimplification of grouping chest pain into classic or typical versus atypical, which can lead to costly delays in treatment for both women and men.  Elizabeth A. Jackson, M.D., F.A.C.C.
结论：归纳总结的ACS女性患者与男性