GAP-CP: Gender, Age, and Presentation in Chest Pain.

Area of Science:

• Cardiology
• Diagnostic Medicine
• Health Services Research

Background:

• Chest pain is a common symptom with diagnostic challenges.
• Presentation and outcomes of chest pain can differ significantly between sexes and age groups.
• Current diagnostic pathways may not adequately account for these variations.

Purpose of the Study:

• To investigate sex and age differences in chest pain presentation, investigation, and coronary artery disease (CAD) severity.
• To compare the effectiveness of different diagnostic strategies in chest pain management.
• To inform the development of sex- and age-specific triage strategies for chest pain.

Main Methods:

• Retrospective cohort study of 10,220 patients referred to a UK Rapid Access Chest Pain Clinic (2018-2024).
• Patients categorized by sex, age group, and chest pain type (typical, atypical, non-cardiac).
• Assessment of investigation pathways and CAD severity (invasive angiography, non-invasive imaging).

Main Results:

• Men were more likely to report typical chest pain and undergo invasive angiography.
• Women more often presented atypically and received non-invasive imaging.
• In patients with typical chest pain, men, especially older men, had significantly higher rates of severe CAD on angiography.

Conclusions:

• Sex- and age-specific risk stratification is crucial for accurate chest pain diagnosis.
• Risk-based models (e.g., ESC approach) are superior to a universal computed tomography coronary angiography (CTCA)-first pathway (NICE recommendation).
• Tailored diagnostic strategies can improve accuracy, reduce delays, and optimize identification of high-risk patients for significant coronary disease.