Gender-specific uncertainties in the diagnosis of acute coronary syndrome.

Abstract

It is unknown whether higher rates of delayed diagnosis and misdiagnosis of acute coronary syndrome (ACS) in women might have contributed to the poorer outcome of women. In a prospective diagnostic multicenter study, we recruited patients presenting to the emergency department (ED) with any kind of chest discomfort/chest pain with onset or peak within the last 12h. We quantified early diagnostic uncertainty for the presence of ACS among treating physicians at the ED after 90min, possibly responsible for delayed diagnosis, using a visual analogue scale. Late diagnostic uncertainty, possibly responsible for misdiagnosis, was defined as disagreement among two independent cardiologists' adjudication of the final diagnosis after complete work-up. Among 2795 patients (897 women and 1898 men), ACS was the adjudicated final diagnosis in 24% of women and 35% of men. Early diagnostic accuracy of clinical judgment of the ED physician for ACS as quantified by the area under the receiver-operating characteristics curve was 0.89 (95% CI 0.87-0.92) in women and 0.86 (95% CI 0.85-0.88) in men (p=0.046). Late diagnostic uncertainty regarding the diagnosis of ACS was 5% in women and 7% in men (p=0.069). Diagnostic uncertainty for the presence of ACS in women is not more common as compared to men and does, therefore, not explain the poorer outcome observed in women with ACS. URL: http://www.clinicaltrials.gov . Unique identifier: NCT00470587.