Association of Accompanying Dyspnoea with Diagnosis and Outcome of Patients Presenting with Acute Chest Discomfort

Overview

Journal Eur Heart J Acute Cardiovasc Care

Publisher Oxford University Press

Specialty Cardiology & Vascular Diseases

Date 2023 Mar 14

PMID 36917461

Authors

Jasper Boeddinghaus

Thomas Nestelberger

Luca Koechlin

Pedro Lopez-Ayala

Desiree Wussler

Maximilian Mais

Luca Zwimpfer

Tobias Zimmermann

Karin Wildi

Maria Rubini Gimenez

Ivo Strebel

Oscar Miro

F Javier Martin-Sanchez

Jiri Parenica

Dagmar I Keller

Danielle M Gualandro

Christian H Nickel

Roland Bingisser

Michael Christ

Christian Mueller

Affiliations

Soon will be listed here.

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.

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