Purpose: We aimed to contribute to an improvement in the management of women with suspected acute myocardial infarction (AMI) by exploring gender-specific chest pain characteristics (CPC).

Methods: We enrolled 2475 consecutive patients (796 women and 1679 men) presenting with acute chest pain to the emergency department (ED) in a prospective multicenter study. The gender-specific diagnostic performance of 34 predefined CPC was evaluated in the early diagnosis of AMI.

Results: AMI was the adjudicated final diagnosis in 18% of women and in 22% of men. Overall, the symptoms reported by women with suspected AMI differed from those reported by men. The capability of most CPC to diagnose AMI was low in women as well as in men with positive likelihood ratios (LR) close to 1 (ranging from 0.25 to 2.27, mean value 1.03, SD of ± 0.35) and rather large 95% confidence intervals. However some CPC significantly increased the likelihood for the diagnosis of AMI (pain aggravated by exertion or relieved by nitrates, pain location on the mid-chest and/or right chest, pain area over 3 cm, radiation to the left and/or right shoulder/arm, and more severe pain as quantified on the VAS) and others significantly decreased the likelihood for the diagnosis of AMI (stabbing pain, aggravation of the pain by breathing, movement or palpation, pain location on the left chest and inframamilar, pain without radiation and pain duration less than 2 minutes). But comparing male and female patients, most of the predefined chest pain criteria tended to increase or decrease the likelihood for AMI similarly showing no significant differences between genders. (p>0.05)

Conclusion: CPC reported by women with suspected AMI differ from those reported by men; nevertheless the diagnostic performance was similar in women and men and did therefore not allow to establish a women-specific strategy which would help physicians to differentiate between women with AMI from women without AMI at the ED