Early Recognition of Acute Myocardial Infarction in Women: Validation of the Mapmiss Tool and Exploration of Care–seeking Delays

Acute myocardial infarction in women is challenging to recognise early because symptoms are frequently atypical, varied, underestimated, and may appear long before the acute event. Gender stereotypes such as the Yentl syndrome, together with biological, cultural and social factors, reduce women’s risk awareness and delay help–seeking. Additional barriers include family responsibilities, previous healthcare experiences, and the influence of relatives on decision–making.The study had two aims (a) to validate an Italian version of the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS), evaluate its predictive capacity, test a possible cut–off score to facilitate its implementation in screening contexts, and identify prodromal symptom clusters (thoracic and general) in women with AMI; (b) to describe behaviours and factors causing delays in accessing care for women affected by AMI. A multicentre observational design was used for the validation phase, including linguistic and cultural adaptation, a pilot test with AMI patients, and test–retest reliability in a subgroup reassessed after 7–14 days. Predictive validity and symptom clustering were evaluated by comparing women with AMI enrolled within five days of the event with healthy controls recruited in outpatient cardiology settings. For the qualitative phase, 22 phenomenological interviews were conducted with women hospitalised within five days after PCI. Among 125 participants (52 AMI; 73 controls), women with AMI most frequently reported chest pain, unusual fatigue, sleep disturbances, and anxiety. The MAPMISS showed excellent internal consistency (α ≥ 0.90), strong test–retest reliability (r = 0.973), and high predictive accuracy, with an optimal cut–off demonstrating good sensitivity and specificity. Logistic regression confirmed a significant association between general and chest symptoms and AMI onset. The qualitative analysis revealed five themes: vivid memory of the event, knowledge and perceptions of AMI, decision–making and help–seeking, influence of others, and reflections on post–AMI choices. Overall, women often misinterpret prodromal symptoms, delaying diagnosis; the MAPMISS identifies key predictive clusters, and cognitive, emotional and social factors contribute to delays, underscoring the importance of screening tools, awareness, and nursing support.