Sensitivity, Specificity, and Sex Differences in Symptoms of Acute Coronary Syndrome

Purpose: Clinical symptoms are part of the risk stratification approaches used in the emergency department (ED) to evaluate patients with suspected acute coronary syndrome (ACS). The purpose of this study was to determine the sensitivity, specificity, and predictive value of 13 symptoms for a diagnosis of ACS in women and men.

Methods: The sample included 736 patients admitted to four EDs with symptoms suggestive of ACS. Symptoms were assessed with the 13-item validated ACS Symptom Checklist. Mixed-effects logistic regression models were used to estimate sensitivity, specificity, and predictive value of each symptom for a diagnosis of ACS, adjusting for age, obesity, stair climbing ability, and diabetes.

Results: Patients were predominantly male (63%) and Caucasian (70.5%), with a mean age of 59.7 ± 14.2 years. Chest pressure, chest discomfort, and chest pain demonstrated the highest sensitivity for ACS in both women (66%, 67%, and 66%) and men (63%, 69%, and 72%). Six symptoms were specific for a non-ACS diagnosis in both women and men. The predictive value of shoulder (OR = 2.06, 95% CI = 1.09-3.87) and arm pain (OR 2.27, 95% CI = 1.20-4.35) in women was nearly twice that of men (OR = 1.14, 95% CI = 0.69-1.87 and OR = 1.24, 95% CI = 0.76-2.02). Shortness of breath (OR = 0.44, 95% CI = 0.28-0.71) and unusual fatigue (OR = 0.62, CI = 0.40-0.99) predicted a non-ACS diagnosis in men.

Conclusions: There were more similarities than differences in symptom predictors of ACS for women and men. Shortness of breath, arm pain, and shoulder pain may be key symptoms which add predictive value to an ACS diagnosis for women.