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June 20, 2012

Sex Differences in Presentation of Myocardial Infarction—Reply

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: Center for Cardiovascular Prevention, Research and Education, Watson Clinic LLP, Lakeland, Florida (Dr Canto; jcanto@watsonclinic.com); and Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (Drs Goldberg and Kiefe).

JAMA. 2012;307(23):2486-2487. doi:10.1001/jama.2012.5287

In Reply: Successful outcomes research using registry data requires formulating clearly stated hypotheses prior to data analysis.1 We examined sex differences in MI symptom presentation (primary objective) and subsequent hospital mortality (secondary objective) after accounting for age among 1.1 million patients enrolled in the National Registry of Myocardial Infarction over the past decade. In our study, chest pain/discomfort was a common symptom of MI seen in more than two-thirds of the overall study population. However, the absence of chest pain/discomfort was more likely in women than in men (42.0% vs 30.7%, respectively). We demonstrated that younger women were more likely to present without chest pain/discomfort and had higher hospital mortality than similarly aged younger men (<55 years of age), but sex differences in presentation and mortality were markedly attenuated and nearly disappeared with increasing age.