Canadian Journal of Cardiology 31 (2015) 365.e1 www.onlinecjc.ca
Letters to the Editor Reply to Letter From DeVon et al. d Time to Standardize and Broaden the Criteria of Acute Coronary Syndrome Symptom Presentations in Women To the Editor: Prompt recognition of the signs and symptoms of acute myocardial infarction (AMI) is vital to the receipt of timely therapies and improved patient outcomes. We agree with Devon and colleagues,1 that the terms “typical” and “atypical” to describe symptom presentation might be misleading, and we must instead work to continue to accurately characterize the full range of AMI symptoms especially because of the substantial overlap of such symptoms among women and men. Furthermore, there are similarities of symptoms among patients who develop AMI with those of other noncardiac diagnoses that make proper triage and risk stratification challenging. As emphasized in our review, the published literature lacks standardization in characterizing AMI symptom presentation, reporting on acute or premonitory symptoms, and primary vs secondary symptoms.2 Reports on AMI symptom presentation vary widely, with some studies revealing apparent differences in presentation, and others show similarities according to age, sex, or race.3 This confusion might be attributed in part to a lack of standardization in the collection of AMI symptom presentation, which makes comparative analyses between published reports difficult.3 We have previously proposed that key data elements be collected using common definitions to help standardize the
recording and analysis of information about symptoms in the wide spectrum of acute coronary syndromes, and potentially allow for comparative analyses between different data sets and published reports.2,3 We fully support using an Acute Coronary Syndromes Symptom Checklist as developed by Devon et al.1 to standardize the symptoms of AMI, which might be used for clinical and research purposes to further advance our field. John G. Canto, MD, MSPH [email protected] Elizabeth A. Canto Robert J. Goldberg, PhD Disclosures The authors have no conflicts of interest to disclose. References 1. DeVon HA, Rosenfield AG, Dya M. In response to Canto et al.eTime to Standardize and Broaden the Criteria of Acute Coronary Syndrome Symptom Presentations in Women. Can J Cardiol 2015;31:364.e13 2. Canto JG, Canto EA, Goldberg RJ. Time to standardize and broaden the criteria of acute coronary syndrome symptom presentations in women. Can J Cardiol 2014;30:721-8. 3. Canto JG, Goldberg RJ, Sopko G. A call to standardize symptom presentation in acute coronary syndromes. Am Heart J 2012;164:801-6.
http://dx.doi.org/10.1016/j.cjca.2014.10.017 0828-282X/Ó 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
Letters to the Editor Reply to Letter From DeVon et al. d Time to Standardize and Broaden the Criteria of Acute Coronary Syndrome Symptom Presentations in Women To the Editor: Prompt recognition of the signs and symptoms of acute myocardial infarction (AMI) is vital to the receipt of timely therapies and improved patient outcomes. We agree with Devon and colleagues,1 that the terms “typical” and “atypical” to describe symptom presentation might be misleading, and we must instead work to continue to accurately characterize the full range of AMI symptoms especially because of the substantial overlap of such symptoms among women and men. Furthermore, there are similarities of symptoms among patients who develop AMI with those of other noncardiac diagnoses that make proper triage and risk stratification challenging. As emphasized in our review, the published literature lacks standardization in characterizing AMI symptom presentation, reporting on acute or premonitory symptoms, and primary vs secondary symptoms.2 Reports on AMI symptom presentation vary widely, with some studies revealing apparent differences in presentation, and others show similarities according to age, sex, or race.3 This confusion might be attributed in part to a lack of standardization in the collection of AMI symptom presentation, which makes comparative analyses between published reports difficult.3 We have previously proposed that key data elements be collected using common definitions to help standardize the
recording and analysis of information about symptoms in the wide spectrum of acute coronary syndromes, and potentially allow for comparative analyses between different data sets and published reports.2,3 We fully support using an Acute Coronary Syndromes Symptom Checklist as developed by Devon et al.1 to standardize the symptoms of AMI, which might be used for clinical and research purposes to further advance our field. John G. Canto, MD, MSPH [email protected] Elizabeth A. Canto Robert J. Goldberg, PhD Disclosures The authors have no conflicts of interest to disclose. References 1. DeVon HA, Rosenfield AG, Dya M. In response to Canto et al.eTime to Standardize and Broaden the Criteria of Acute Coronary Syndrome Symptom Presentations in Women. Can J Cardiol 2015;31:364.e13 2. Canto JG, Canto EA, Goldberg RJ. Time to standardize and broaden the criteria of acute coronary syndrome symptom presentations in women. Can J Cardiol 2014;30:721-8. 3. Canto JG, Goldberg RJ, Sopko G. A call to standardize symptom presentation in acute coronary syndromes. Am Heart J 2012;164:801-6.
http://dx.doi.org/10.1016/j.cjca.2014.10.017 0828-282X/Ó 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
