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any studies of sex-related differences in the shortand long-term outcomes of acute myocardial infarction (AMI) have concluded that mortality is higher among women than men. [1][2][3][4][5][6][7][8][9][10] The reason for poorer outcomes in women remains unclear. The higher mortality among women may be partially explained by the fact that women were older than men and had higher rates of unfavorable prognostic factors in previous studies. After the adjustment for these factors, however, several studies continued to show a survival disadvantage for women. 2,3,5,8 The persistence of higher mortality after risk adjustment may be because women usually receive less aggressive treatment for AMI than men. 2,3,8,11 However, analyses adjusting for baseline differences between women and men have yielded conflicting results. Several studies have found that sex is an independent risk factor for increased mortality after AMI, 1,4 whereas others have not. 6,7,12 Another potential explanation for the higher mortality among women is delayed presentation to the hospital. 13,14 In general, women with AMI present to the hospital later than men, suggesting different behavioral responses. Women have been reported to be less likely than men to believe that they are having a heart attack when they experience symptoms of AMI. 15 Several studies have reported that women have different or less typical symptoms of AMI than men. 14,16,17 Women are more likely to have non-chest pain, nausea or vomiting (or both), and shortness of breath. 14,17-20 These atypical symptoms may make it difficult for not only women with AMI, but also bystanders and health-care providers to correctly interpret the situation and take appropriate action. An important limitation of previous studies examining sexrelated differences in symptom presentation among patients with AMI was their retrospective design. Patients were interviewed by many different physicians, without the use of a standardized interview form. The results of interviews were thus subject to bias. More importantly, studies of sex-related differences in symptoms at the onset of AMI are lacking in Japan.To examine sex-related differences in the clinical features of ST-segment elevation AMI in Japan, we prospectively studied a series of men and women who were admitted to the coronary care unit of our Medical Center. In this pilot study, the same cardiologist interviewed all patients within 48 h after admission to minimize interview-related bias. Methods Study GroupFrom January 2001 through December 2004, 510 consecutive patients with ST-segment elevation AMI were admitted to our coronary care unit within 24 h after symp- Background Many studies have examined sex-related differences in the clinical features of acute myocardial infarction (AMI). However, prospective studies are scant, and sex-related differences in symptoms of AMI remain unclear. We examined differences between men and women in terms of the clinical features of ST-segment elevation AMI. Methods and ResultsWe studied 457 patients (106 wome...

Background The significance of inverted T waves remains unclear in patients with acute pulmonary embolism (PE). Methods and ResultsThe relationship of the number of leads with inverted T waves to the severity of PE in 40 patients with acute PE was studied. Patients were classified into 3 groups according to the number of leads with inverted T waves on the admission electrocardiogram (ECG): 15 patients, ≤3 leads (group L); 12 patients, 4-6 leads (group M); and 13 patients, ≥7 leads (group H). In groups L, M and H, the rates of right ventricular dysfunction on echocardiography were 47%, 92% and 100% (p<0.01), respectively, and the rates of in-hospital complicated events (including death or the need for catecholamine support, cardiopulmonary resuscitation or mechanical cardiovascular support because of hemodynamic instability) were 0%, 8% and 46% (p=0.004), respectively. On multivariate analysis, arterial hypotension at presentation (odds ratio (OR) 8.96, p=0.049) and inverted T waves in ≥7 leads on the admission ECG (OR 16.8, p=0.037) were the only independent predictors of in-hospital complicated events. Conclusions The number of leads with inverted T waves may be a useful and simple marker of increased risk for early complications in patients with acute PE. (Circ J 2006; 70: 750 -755)

Plaque rupture is associated with morphologic characteristics of vulnerable lesions, as well as with larger infarcts and a higher incidence of no-reflow phenomenon, suggesting that plaque embolism contributes to the progression of myocardial damage in patients with anterior AMI.