Younger women with an acute coronary syndrome are slightly less likely than men to present with the classic symptom of chest pain, according to a study published in JAMA Internal Medicine. As a result, they often fail to receive a correct diagnosis in the emergency department.

Nadia Khan and colleagues prospectively analyzed data from more than 1,000 ACS patients 55 years of age or younger– 30% of whom were women– participating in the GENESIS PRAXY study.

In these younger patients women were less likely to have chest pain than men (19% of women versus 13.7% for men, p = 0.03).

Women were also more likely than men to have a non-ST-segment elevation myocardial infarction (37.5% vs 30.7%; p = 0.03).

Upon multivariate analysis, women and patients with tachycardia were less likely to have chest pain. The absence of chest pain did not herald any change in the type or severity of the ACS.

Diagnosis of any disease with a lower prevalence but higher mortality, such as coronary artery disease in younger women, is more challenging.

Public health messages should “target both men and women regarding ACS symptom presentation with or without chest pain so as to encourage earlier and more widespread access to appropriate and lifesaving care.