Association of accompanying dyspnoea with diagnosis and outcome of patients presenting with acute chest discomfort.

Abstract

AIMS:

The presence of accompanying dyspnoea is routinely assessed and common in patients presenting with acute chest pain/discomfort to the emergency department (ED). We aimed to assess the association of accompanying dyspnoea with differential diagnoses, diagnostic work-up, and outcome.

METHODS AND RESULTS:

We enrolled patients presenting to the ED with chest pain/discomfort. Final diagnoses were adjudicated by independent cardiologists using all information including cardiac imaging. The primary diagnostic endpoint was the final diagnosis. The secondary diagnostic endpoint was the performance of high-sensitivity cardiac troponin (hs-cTn) and the European Society of Cardiology (ESC) 0/1h-algorithms for the diagnosis of myocardial infarction (MI). The prognostic endpoints were cardiovascular and all-cause mortality at two years. Among 6045 patients, 2892/6045 (48%) had accompanying dyspnoea. The prevalence of acute coronary syndrome (ACS) in patients with vs. without dyspnoea was comparable (MI 22.4% vs. 21.9%, P = 0.60, unstable angina 8.7% vs. 7.9%, P = 0.29). In contrast, patients with dyspnoea more often had cardiac, non-coronary disease (15.3% vs. 10.2%, P < 0.001). Diagnostic accuracy of hs-cTnT/I concentrations was not affected by the presence of dyspnoea (area under the curve 0.89-0.91 in both groups), and the safety of the ESC 0/1h-algorithms was maintained with negative predictive values >99.4%. Accompanying dyspnoea was an independent predictor for cardiovascular and all-cause death at two years [hazard ratio 1.813 (95% confidence intervals, 1.453-2.261, P < 0.01)].

CONCLUSION:

Accompanying dyspnoea was not associated with a higher prevalence of ACS but with cardiac, non-coronary disease. While the safety of the diagnostic work-up was not affected, accompanying dyspnoea was an independent predictor for cardiovascular and all-cause death.

CLINICAL TRIAL REGISTRATION:

https://clinicaltrials.gov/ct2/show/NCT00470587, number NCT00470587.

• Authors: Jasper Boeddinghaus, Thomas Nestelberger, Luca Koechlin, Pedro Lopez-Ayala, Desiree Wussler, Maximilian Mais, Luca Zwimpfer, Tobias Zimmermann, Karin Wildi, Maria Rubini Giménez, Ivo Strebel, Òscar Miró, F Javier Martin-Sanchez, Jiri Parenica, Dagmar I Keller, Danielle M Gualandro, Christian H Nickel, Roland Bingisser, Michael Christ, Christian Mueller, APACE investigators
• Journal: European heart journal. Acute cardiovascular care (Eur Heart J Acute Cardiovasc Care) Vol. 12 Issue 5 Pg. 283-295 (May 04 2023) ISSN: 2048-8734 [Electronic] England
• PMID: 36917461 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: [email protected].

Chemical References

• Biomarkers
• Troponin T

Topics

• Humans
• Myocardial Infarction (diagnosis)
• Predictive Value of Tests
• Acute Coronary Syndrome
• Prognosis
• Chest Pain (diagnosis, etiology)
• Dyspnea (diagnosis, epidemiology, etiology)
• Biomarkers
• Troponin T