530 SEX DIFFERENCES IN PRODROMAL SYMPTOMS AND HEALTH SEEKING BEHAVIORS FOR ACUTE CORONARY SYNDROME N Khan, M Avgil, C Norris, R Pelletier, S Bacon, G Thanassoulis, SS Daskalopoulou, H Behlouli, I Karp, L Pilote; GENESIS-PRAXY Investigators Montréal, Québec INTRODUCTION: Many women, especially when younger, do not recognize their risk for coronary heart disease, or seek medical care for their cardiac symptoms. Prodromal cardiac symptoms occur prior to acute coronary syndrome (ACS) and may provide an opportunity for early intervention. We sought to determine the association between prodromal symptoms, treatment-seeking behaviors among young men women, and arrival time to the emergency department for ACS. METHODS: We conducted a prospective cohort study of 1023 patients (30% women) aged 55 years or less, hospitalized for ACS and enrolled in the GENESIS PRAXY (GENdEr and Sex DetermInantS of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary SYndrome) study (January 2009-September 2012). The McSweeney Acute and Prodromal Myocardial Infarction Symptom questionnaire, administered during hospitalization and medical records were used to assess the presence and intensity of 33 prodromal symptoms prior to onset of ACS symptoms. Prodromal symptoms were considered if they were at least moderate intensity. Patients also completed a questionnaire on treatment seeking behaviours and chart review was used to determine time from onset of ACS symp- toms to admission to the emergency department. RESULTS: The median age of women and men was 49 years. 51% of women and 63% of men had ST-elevation myocardial infarction. 93% of women and 87% of men presented with prodromal symptoms (p¼0.004 for sex difference). The most common symptoms for were similar in women and men and included feeling tired, sleepiness, anxiety, arm weakness and arm pain; 23% of both women and men reported chest pain prior to their ACS event. Men who reported prodromal symptoms tended to present with classic chest pain findings during ACS, whereas women who reported prodromal symp- toms were equally likely to present with or without chest pain during ACS. Women were more likely to seek medical care at their doctor's office prior to ACS for their prodromal symptoms (51%) compared to men (39%, p¼0.004). However, time of arrival to emergency departments from onset of ACS symptoms was generally similar between women and men with prodromal symptoms (6.4 hours vs. 5.7 hours, p¼0.2). CONCLUSION: Prodromal symptoms occur frequently in young men and women prior to ACS. Although most prodromal symptoms are non-specific, almost one in four patients report prodromal chest pain with a substantial proportion seeking medical attention. Awareness of prodromal symptoms may allow for identification of patients at risk for impending ACS. 531 THE PREVALENCE AND INFLUENCE OF CARDIAC PRODROMAL SYMPTOMS IN MEN AND WOMEN ON ACUTE CORONARY SYNDROME (ACS) PAIN SEVERITY S O'Keefe-McCarthy, M McGillion, S Nelson, J Victor, S Clarke, J McFetridge-Durdle, J Jones, C Smith Romeril, A Overhoff, C Moore, C Little, K Kennedy, L Hoar, J Porter Toronto, Ontario BACKGROUND: Convincing evidence identifies cardiac-related prodromal warning symptoms, experienced months to days prior to an acute cardiac event, may be predictive of pain intensity during an acute exacerbation of ACS. This study examined the prevalence and association of pre-hospital prodromal cardiac symptoms with ACS pain intensity, state and trait anxiety. METHODS: A descriptive-correlational design was used to identify prodromal predictors of ACS cardiac pain intensity. One hundred and twenty-one adults admitted to an emer- gency department with ACS completed a prodromal symptom questionnaire related to symptoms, frequency and intensity. Baseline cardiac pain intensity (numeric rating scale-NRS) and state-trait anxiety (Speilberger State -Trait Anxiety Inventory-STAI) were collected and analyzed via multiple variable linear mixed effects regression models. RESULTS: The mean age of ACS patients (n¼121) was 67.6 13, 50% were male, 60% had unstable angina and 40% had Non-ST-Elevated myocardial infarction. There were no differences in prodromal symptom prevalence between men and women. Overall, in unadjusted analysis, increased ACS pain intensity was significantly associated with pre-hospital prodromal symptoms of headaches p¼0.006; sleep disturbance p¼0.012; and anxiety p¼0.017. Similar findings were found following adjustment for age and sex. Prodromal symptoms were not associated with state or trait anxiety scores. CONCLUSION: Preliminary findings suggest that prodromal symptoms, particularly headache, sleep disturbance, and S294 Canadian Journal of Cardiology Volume 29 2013