Chest pain is an unreliable measure of ischemia in men and women during PTCA

OBJECTIVE: To investigate the differences between men and women in ischemia-induced pain, the amount of ST-segment deviation (the ''ST deviation score''), and the relation between pain intensity and ST deviation score. DESIGN: Retrospective, comparative descriptive. SETTING: Cardiac catheterization laboratory of a large, urban, university-affiliated medical center with full cardiac services. PATIENTS: Adults who underwent percutaneous transluminal coronary angioplasty (PTCA) and had electrocardiographic (EGG) evidence of myocardial ischemia during balloon inflation. METHODS: Continuous 12-lead ECGs were recorded during balloon inflation in patients undergoing PTCA. Patients rated pain on a scale of 0 to 10. The total ST deviation score equaled baseline ECG ST minus maximal ST deviation; absolute deviations were totaled. Frequencies, measures of central tendency, or chi-square or t tests were used for data analysis with significance established at p < 0.05. RESULTS: There was no difference in the degree of chest pain between men and women during balloon inflation, nor was ST deviation score associated with pain in either gender. Pain intensity did not correlate with total ST deviation in men (r = 0.02) or women (r = -0.07). CONCLUSIONS: In this study, pain was a poor indicator of ischemia in both sexes during PTCA, and the degree of pain did not correlate with the magnitude of ST deviation. More than one third of men and more than one fourth of women experienced nb chest pain during balloon inflation. Clinicians should consider continuous ST-segment monitoring and patient symptoms to monitor accurately for ischemia.