Korean J Intern Med.  2020 May;35(3):582-592. 10.3904/kjim.2018.320.

Gender differences in the presentation of chest pain in obstructive coronary artery disease: results from the Korean Women’s Chest Pain Registry

Affiliations
  • 1Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
  • 2Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
  • 3Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
  • 4Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
  • 5Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
  • 6Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
  • 7Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
  • 8Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
  • 9Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea

Abstract

Background/Aims
Chest pain in patients with obstructive coronary artery disease (OCAD) is affected by several social factors. The gender-based differences in chest pain among Koreans have yet to be investigated.
Methods
The study consecutively enrolled 1,549 patients (male/female, 514/1,035; 61 ± 11 years old) with suspected angina. The predictive factors for OCAD based on gender were evaluated.
Results
Men experienced more squeezing type pain on the left side of chest, while women demonstrated more dull quality pain in the retrosternal and epigastric area. After adjustment for risk factors, pain in the retrosternal area (odds ratio [OR], 1.491; 95% confidence interval [CI], 1.178 to 1.887) and aggravation by exercise (OR, 2.235; 95% CI, 1.745 to 2.861) were positively associated with OCAD. In men, shorter duration (OR, 1.581; 95% CI, 1.086 to 2.303) and dyspnea (OR, 1.610; 95% CI, 1.040 to 2.490) increased the probability for OCAD, while left-sided chest pain suggested a low probability for OCAD (OR, 0.590; 95% CI, 0.388 to 0.897). In women, aggravation by emotional stress (OR, 0.348; 95% CI, 0.162 to 0.746) and dizziness (OR, 0.457; 95% CI, 0.246 to 0.849) decreased the probability for OCAD.
Conclusions
This is the first study to focus on gender differences in chest pain among Koreans with angina. Symptoms with high probability for OCAD were different between sexes. Our findings suggest that patient’s medical history in pretest assessment for OCAD should be individualized considering gender.

Keyword

Chest pain; Sex characteristics; Coronary artery disease; Angina pectoris
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