Purpose: We explored clinical characteristics and outcome associated with atypical chest pain (CP) in patients with diagnosis of ACS. Methods: Data of 8947 patients (32.4% women) from the International Survey of Acute Coronary Syndrome in Transitional Country (ISACS-TC) were reviewed in our comprehensive coordinating center. Only patients with admission and discharge diagnosis of ACS were considered. Results: There were 778 patients with atypical CP for the index event. These patients were significantly (p<0.001) older than those with typical CP (68 vs. 63 years) and they were more likely to be female (41.3% vs. 31.6%). More frequently (p<0.01), they had history of diabetes (33.2% vs. 25.6%) and hypertension (73.7% vs. 68.6%), but less smoking (21.7% vs. 35.6%) and hypercholesterolemia (39.2% vs 43.6%). Peripheral artery disease (5.3% vs. 3.1%), chronic kidney disease (11.9% vs. 5.6%) and history of stroke (10.7% vs 4.7%) were more frequently (p<0.001) in patients without then with typical CP. Moreover, a greater number (p<0.001) of patients without typical CP compare to those with typical CP had a delay >12 hrs to arrive to hospital; absence of typical CP doubled the probability (OR: 2.18; CI: 1.89–2.55) to late hospital presentation. Interestingly, patients without typical CP were significantly more likely to exhibit signs of heart faliure (42.8% vs. 22.1%), although they less frequently had STEMI as index even. In-hospital mortality rate was in the overall cohort 8.2% (STEMI: 9.1%, NSTEMI: 8.8%, UA: 2.1%). Yet, the mortality was significantly greater for patients with atypical CP (STEMI: 19.8%, NSTEMI: 19.3%) than for those with typical CP (STEMI: 6.7%, NSTEMI: 7.1%). It should be noted, however, that patients with atypical CP were less likely (p<0.001) to receive medications (aspirin 90.4% vs. 96.2%; beta-blockers 66.9% vs. 78.9%) and invasive procedures (21% vs. 47.6%) than patients with typical CP. Conclusions: ACS without typical CP is not a rare experience and it is associated many co-morbidity and poor outcome, both in women and men. Strategies to avoid underestimation of atypical symptoms represent potential opportunities for improving the outcome of these patients.
E. Cenko, B. Ricci, Z. Vasiljevic, D. Trninic, B. Knezevic, O. Gustiene, et al. (2015). Inaccurate treatment and poor outcome in patients with ACS and atypical symptoms. EUROPEAN HEART JOURNAL, 36(suppl 1), 882-882.
Inaccurate treatment and poor outcome in patients with ACS and atypical symptoms
CENKO, EDINA;RICCI, BEATRICE;MANFRINI, OLIVIA;BUGIARDINI, RAFFAELE
2015
Abstract
Purpose: We explored clinical characteristics and outcome associated with atypical chest pain (CP) in patients with diagnosis of ACS. Methods: Data of 8947 patients (32.4% women) from the International Survey of Acute Coronary Syndrome in Transitional Country (ISACS-TC) were reviewed in our comprehensive coordinating center. Only patients with admission and discharge diagnosis of ACS were considered. Results: There were 778 patients with atypical CP for the index event. These patients were significantly (p<0.001) older than those with typical CP (68 vs. 63 years) and they were more likely to be female (41.3% vs. 31.6%). More frequently (p<0.01), they had history of diabetes (33.2% vs. 25.6%) and hypertension (73.7% vs. 68.6%), but less smoking (21.7% vs. 35.6%) and hypercholesterolemia (39.2% vs 43.6%). Peripheral artery disease (5.3% vs. 3.1%), chronic kidney disease (11.9% vs. 5.6%) and history of stroke (10.7% vs 4.7%) were more frequently (p<0.001) in patients without then with typical CP. Moreover, a greater number (p<0.001) of patients without typical CP compare to those with typical CP had a delay >12 hrs to arrive to hospital; absence of typical CP doubled the probability (OR: 2.18; CI: 1.89–2.55) to late hospital presentation. Interestingly, patients without typical CP were significantly more likely to exhibit signs of heart faliure (42.8% vs. 22.1%), although they less frequently had STEMI as index even. In-hospital mortality rate was in the overall cohort 8.2% (STEMI: 9.1%, NSTEMI: 8.8%, UA: 2.1%). Yet, the mortality was significantly greater for patients with atypical CP (STEMI: 19.8%, NSTEMI: 19.3%) than for those with typical CP (STEMI: 6.7%, NSTEMI: 7.1%). It should be noted, however, that patients with atypical CP were less likely (p<0.001) to receive medications (aspirin 90.4% vs. 96.2%; beta-blockers 66.9% vs. 78.9%) and invasive procedures (21% vs. 47.6%) than patients with typical CP. Conclusions: ACS without typical CP is not a rare experience and it is associated many co-morbidity and poor outcome, both in women and men. Strategies to avoid underestimation of atypical symptoms represent potential opportunities for improving the outcome of these patients.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
