{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:45:21Z","timestamp":1791477921029,"version":"4.3.4"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"17","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,9,3]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Sex\u2010specific criteria are recommended for the diagnosis of myocardial infarction, but the impact of these on presenting characteristics is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      We evaluated patient\u2010reported symptoms in 1941 patients (39% women) with suspected acute coronary syndrome attending the emergency department in a substudy of a prospective trial. Standardized criteria defined typical and atypical presentations based on pain nature, location, radiation, and additional symptoms. Diagnosis of myocardial infarction was adjudicated using a high\u2010sensitivity cardiac troponin I assay with sex\u2010specific thresholds (&gt;16\u00a0ng\/L women, &gt;34\u00a0ng\/L men). Patients identified who were missed by the contemporary assay with a uniform threshold (\u226550\u00a0ng\/L) were reclassified by this approach. Type 1 myocardial infarction was diagnosed in 16% (184\/1185) of men and 12% (90\/756) of women, with 9 (5%) men and 27 (30%) women reclassified using high\u2010sensitivity cardiac troponin I and sex\u2010specific thresholds. Chest pain was the presenting symptom in 91% (1081\/1185) of men and 92% (698\/756) of women. Typical symptoms were more common in women than in men with myocardial infarction (77% [69\/90] versus 59% [109\/184];\n                      <jats:italic>P<\/jats:italic>\n                      =0.007), and differences were similar in those reclassified (74% [20\/27] versus 44% [4\/9];\n                      <jats:italic>P<\/jats:italic>\n                      =0.22). The presence of \u22653 typical features was associated with a positive likelihood ratio for the diagnosis of myocardial infarction in women (positive likelihood ratio, 1.18; 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      , 1.03\u20131.31) but not in men (positive likelihood ratio 1.09; 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      , 0.96\u20131.24).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Typical symptoms are more common and have greater predictive value in women than in men with myocardial infarction whether or not they are diagnosed using sex\u2010specific criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Clinical Trial Registration<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      <jats:styled-content style=\"fixed-case\">URL<\/jats:styled-content>\n                      :\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov\">http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      . Unique identifier\n                      <jats:styled-content style=\"fixed-case\">NCT<\/jats:styled-content>\n                      01852123.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.119.012307","type":"journal-article","created":{"date-parts":[[2019,8,21]],"date-time":"2019-08-21T00:01:14Z","timestamp":1566345674000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":132,"title":["Presenting Symptoms in Men and Women Diagnosed With Myocardial Infarction Using Sex\u2010Specific Criteria"],"prefix":"10.1161","volume":"8","author":[{"given":"Amy V.","family":"Ferry","sequence":"first","affiliation":[{"name":"BHF Centre for Cardiovascular Science University of Edinburgh United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atul","family":"Anand","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science University of Edinburgh United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona E.","family":"Strachan","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science University of Edinburgh United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leanne","family":"Mooney","sequence":"additional","affiliation":[{"name":"Royal Victoria Hospital Kirkcaldy United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey D.","family":"Stewart","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science University of Edinburgh United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Marshall","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science University of Edinburgh United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew R.","family":"Chapman","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science University of Edinburgh United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuan Ken","family":"Lee","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science University of Edinburgh United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Jones","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science University of Edinburgh United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Orme","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science University of Edinburgh United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anoop S. V.","family":"Shah","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science University of Edinburgh United Kingdom"},{"name":"Usher Institute of Population Health Sciences and Informatics University of Edinburgh United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas L.","family":"Mills","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science University of Edinburgh United Kingdom"},{"name":"Usher Institute of Population Health Sciences and Informatics University of Edinburgh United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000617"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31826e1058"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31923-8"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.086892"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000351"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2016-309938"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.031650"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv320"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2007.138537"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.167.22.2405"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.199"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.12199"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.113.000586"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2012.05.008"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu189"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00391-8"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g7873"},{"key":"e_1_3_2_19_2","first-page":"1863","article-title":"Sex differences in acute coronary syndrome symptom presentation in young patients","volume":"173","author":"Khan NA","year":"2013","unstructured":"Khan NA, Daskalopoulou SS, Karp I, Eisenberg MJ, Pelletier R, Tsadok MA, Dasgupta K, Norris CM, Pilote L. 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Accessed July 3 2019."}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.119.012307","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T07:36:13Z","timestamp":1715585773000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.119.012307"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9,3]]},"references-count":30,"journal-issue":{"issue":"17","published-print":{"date-parts":[[2019,9,3]]}},"alternative-id":["10.1161\/JAHA.119.012307"],"URL":"https:\/\/doi.org\/10.1161\/jaha.119.012307","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9,3]]},"assertion":[{"value":"2019-02-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-06-24","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-08-20","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e012307"}}