Acute coronary syndromes presentations and care outcomes in white, South Asian and Chinese patients: a cohort study

King‐Shier, Kathryn; Quan, Hude; Kapral, Moira K.; Tsuyuki, Ross T.; An, Lê Văn; Banerjee, Suvro; Southern, Danielle; Khan, Nadia

doi:10.1136/bmjopen-2018-022479

Cited by 27 publications

(21 citation statements)

References 31 publications

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“…Although the three-wheeler has not been a safe option to transport an emergency patient [30], it has been the widely available transport facility in Sri Lanka, as evident by this study. In those who had STEMI, the delay in the presentation was more in females (6:04) than males (3:55), con rming the ndings from the previous studies that women show a more signi cant delay in presentation than men [2,8,14,22,29]. One reason for this may be that women show more atypical symptoms of ACS than men [24,29].…”

Section: Discussionsupporting

confidence: 79%

“…In those who had STEMI, the delay in the presentation was more in females (6:04) than males (3:55), con rming the ndings from the previous studies that women show a more signi cant delay in presentation than men [2,8,14,22,29]. One reason for this may be that women show more atypical symptoms of ACS than men [24,29].…”

Section: Discussionsupporting

confidence: 79%

“…The average delay in presentation to the health care facility from the onset of symptoms in ACS patients has been between 1.5 to 2.5 hours, as revealed by several studies [8,28,29]. Thus, patients with STEMI do not seek medical care for approximately 1.5 to 2 hours after symptom onset, and little change in this interval has occurred over the past ten years [8].…”

Section: Discussionmentioning

confidence: 99%

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The Influence of Sex on Navigating Acute Coronary Syndrome: A Hospital-Based Cohort Study in South Asia

Ralapanawa

Karunathilake

Bandara

et al. 2021

Preprint

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BackgroundThe cardiovascular risk profile and adverse events following acute coronary syndrome (ACS) differ between the Sex, indicating the importance of studying the sex differences in factors associated with ACS.MethodsA cross-sectional descriptive study was performed among ACS patients presented to Teaching Hospital Peradeniya. An interviewer-administered prevalidated questionnaire was used to collect data, and analysis was done. ResultsA total of 789 patients were included, consisting of 40.4% females. The mean age of females (62.17±11.06) was higher than males (59.80±11.24) (p=0.004), and in females, the mean age for unstable angina (60.5±10.5) was lower than NSTEMI (63.8±12.5) (p=0.022) and STEMI (64.0±9.2) (p=0.026). The male-female composition for unstable angina (46.3% vs 53.7%) and STEMI (75.8% vs 24.2%) showed varied proportions. The mean BMI (24.95±4.40 kg m-3 vs 23.77±3.88 kg m-3) (p=0.008) and obesity (21.6% vs 13.8%) (p=0.048) was higher in females. Overweight (9.4% vs 8.8%) (p=0.048) and the waist-hip ratio (0.98±0.07 vs 0.94±0.10) (p=0.006) was higher in males. Family history of hypertension was higher in females (24.1% vs 17.0%) (p=0.014). Most of the females were co-morbid with diabetes (37.9%) (p=0.008), hypertension (59.8%) (p<0.001) and dyslipidaemia (40.3%) (p<0.001) than males. The prevalence of smoking and alcohol intake was significantly higher in males (p<0.001). The predominant symptom was chest pain (93.4%), regardless of Sex. Right chest pain was primarily present in females (8.0% vs 3.6%) (p=048), and radiation of pain to the right arm mainly occurred in males (18.2% vs 7.5%) (p=0.007). Vomiting and dyspnoea was higher in females (47.7% vs 38.4%, p=0.049 and 53.1% vs 43.2%, p=0.039). The delay in presentation to the hospital was more in females (6:04±6:02) than males (3:55±4:22) with STEMI. The commonest reason for the delay was not suspecting an ACS, and a three-wheeler was the primary mode of transport in both sexes without any sex difference. Only 7.0% was delayed due to the unavailability of a transport facility.ConclusionFemale and male patients with ACS show differences in the age of onset, the spectrum of ACS, comorbidities, anthropometric measurements, risk factors like smoking and alcohol intake, clinical presentation aspects and delay in presentation to the hospital.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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The Influence of Sex on Navigating Acute Coronary Syndrome: A Hospital-Based Cohort Study in South Asia

Ralapanawa

Karunathilake

Bandara

et al. 2021

Preprint

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“…25 Another ED study among 1334 patients Open access with ACS showed that regardless of ethnics status, the most common presenting symptom was retrosternal pain/discomfort of any intensity. 26 The aforementioned US study in the ED setting reported that radiation to the arm was associated with ACS in women but not for men, and chest pressure was associated with ACS for men but not in women. 13 The only previously published OHS-PC study reported the opposite; radiation to the arm was associated with ACS in men but not in women.…”

Section: Discussionmentioning

confidence: 97%

Gender-stratified analyses of symptoms associated with acute coronary syndrome in telephone triage: a cross-sectional study

et al. 2021

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ObjectivesTo identify clinical variables that are associated with the diagnosis acute coronary syndrome (ACS) in women and men with chest discomfort who contact out-of-hours primary care (OHS-PC) by telephone, and to explore whether there are indications whether these variables differ among women and men.DesignCross-sectional study in which we compared patient and call characteristics of triage call recordings between women with and without ACS, and men with and without ACS.SettingNine OHS-PC in the Netherlands.Participants993 women and 802 men who called OHS-PC for acute chest discomfort (pain, pressure, tightness or discomfort) between 2014 and 2016.Primary outcome measureDiagnosis of ACS retrieved from the patient’s medical record in general practice, including hospital specialists’ discharge letters.ResultsAmong 1795 patients (mean age 58.8 (SD 19.5) years, 55.3% women), 15.0% of men and 8.6% of women had an ACS. In both sexes, retrosternal chest pain was associated with ACS (women with ACS vs without 62.3% vs 40.3%, p=0.002; men with ACS vs without 52.5% vs 39.7%, p=0.032; gender interaction, p=0.323), as was pressing/heavy/tightening pain (women 78.6% vs 61.5%, p=0.011; men 82.1% vs 57.4%, p=<0.001; gender interaction, p=0.368) and radiation to the arm (women 75.6% vs 45.9%, p<0.001; men 56.0% vs 34.8%, p<0.001; gender interaction, p=0.339). Results indicate that only in women were severe pain (65.4% vs 38.1%, p=0.006; gender interaction p=0.007) and radiation to jaw (50.0% vs 22.9%, p=0.007; gender interaction p=0.015) associated with ACS.Ambulances were dispatched equally in women (72.9%) and men with ACS (70.0%).ConclusionOur results indicate there were more similarities than differences in symptoms associated with the diagnosis ACS for women and men. Important exceptions were pain severity and radiation of pain in women. Whether these differences have an impact on predicting ACS needs to be further investigated with multivariable analyses.Trial registration numberNTR7331.

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“…Finally , our cohorts are mainly constituted by White Caucasians, and transposition of our results to populations with other race predominance has to be cautious, as chest pain characteristics may vary among different races. 23…”

Section: Discussionmentioning

confidence: 99%

External validation of an emergency department triage algorithm for chest pain patients

Miró

Lopez-Ayala

Martínez‐Nadal

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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Background We aimed to externally validate an emergency department triage algorithm including five hierarchical clinical variables developed to identify chest pain patients at low risk of having an acute coronary syndrome justifying delayed rather than immediate evaluation. Methods In a single-centre cohort enrolling 29,269 consecutive patients presenting with chest pain, the performance of the algorithm was compared against the emergency department discharge diagnosis. In an international multicentre study enrolling 4069 patients, central adjudication by two independent cardiologists using all data derived from cardiac work-up including follow-up served as the reference. Triage towards ‘low-risk’ required absence of all five clinical ‘high-risk’ variables: history of coronary artery disease, diabetes, pressure-like chest pain, retrosternal chest pain and age above 40 years. Safety (sensitivity and negative predictive value (NPV)) and efficacy (percentage of patients classified as low risk) was tested in this initial proposal (Model A) and in two additional models: omitting age criteria (Model B) and allowing up to one (any) of the five high-risk variables (Model C). Results The prevalence of acute coronary syndrome was 9.4% in the single-centre and 28.4% in the multicentre study. The triage algorithm had very high sensitivity/NPV in both cohorts (99.4%/99.1% and 99.9%/99.1%, respectively), but very low efficacy (6.2% and 2.7%, respectively). Model B resulted in sensitivity/NPV of 97.5%/98.3% and 96.1%/89.4%, while efficacy increased to 14.2% and 10.4%, respectively. Model C resulted in sensitivity/NPV of 96.7%/98.6% and 95.2%/91.3%, with a further increase in efficacy to 23.1% and 15.5%, respectively. Conclusion A triage algorithm for the identification of low-risk chest pain patients exclusively based on simple clinical variables provided reasonable performance characteristics possibly justifying delayed rather than immediate evaluation in the emergency department.

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Acute coronary syndromes presentations and care outcomes in white, South Asian and Chinese patients: a cohort study

Cited by 27 publications

References 31 publications

The Influence of Sex on Navigating Acute Coronary Syndrome: A Hospital-Based Cohort Study in South Asia

The Influence of Sex on Navigating Acute Coronary Syndrome: A Hospital-Based Cohort Study in South Asia

Gender-stratified analyses of symptoms associated with acute coronary syndrome in telephone triage: a cross-sectional study

External validation of an emergency department triage algorithm for chest pain patients

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