Kristian Hellenkamp1, Harald Darius2, Evangelos Giannitsis3, Raimund Erbel4, Michael Haude5, Christian Hamm6, Gerd Hasenfuss1, Gerd Heusch7, Harald Mudra8, Thomas Münzel9, Claus Schmitt10, Burghard Schumacher11, Jochen Senges12, Thomas Voigtländer13, Lars S Maier14. 1. Clinic for Cardiology & Pneumology. Heart Centre Georg-August-University Göttingen, Germany. 2. Dept. of Cardiology, Angiology & Intensive Care Medicine, Vivantes Hospital Neukölln, Berlin, Germany. 3. Dept. of Cardiology, Angiology & Pneumology, Ruprecht-Karls-University Heidelberg, Germany. 4. Dept. of Cardiology, West-German Heart Centre University Essen, Germany. 5. Dept. of Cardiology & Nephrology, Lukas Hospital Neuss, Germany. 6. Dept. of Cardiology, Kerckhoff Klinik Bad Nauheim, Germany. 7. Institute for Pathophysiology, University of Duisburg-Essen, Germany. 8. Dept. of Cardiology, Pneumology and Internal Intensive Care Medicine, Klinikum Neuperlach, Städtisches Klinikum München GmbH, München, Germany. 9. Dept. of Cardiology, Angiology & Intensive Care Medicine, Johannes Gutenberg University Mainz, Germany. 10. Clinic for Cardiology and Angiology, Städtisches Klinikum Karlsruhe, Germany. 11. 2nd Dept. of Medicine, Westpfalzklinikum Kaiserslautern, Germany. 12. Foundation Institut für Herzinfarktforschung Ludwigshafen, Germany. 13. Centre for Cardiology and Angiology Frankfurt, Germany. 14. Department of Internal Medicine II, University Hospital Regensburg, Germany. Electronic address: lars.maier@ukr.de.
Abstract
BACKGROUND: While dyspnea is a common symptom in patients admitted to Chest Pain Units (CPUs) little is known about the impact of dyspnea on their outcome. The purpose of this study was to evaluate the impact of dyspnea on the short-term outcome of CPU patients. METHODS: We analyzed data from a total of 9169 patients admitted to one of the 38 participating CPUs in this registry between December 2008 and January 2013. Only patients who underwent coronary angiography for suspected ACS were included. 2601 patients (28.4%) presented with dyspnea. RESULTS: Patients with dyspnea at admission were older and frequently had a wide range of comorbidities compared to patients without dyspnea. Heart failure symptoms in particular were more common in patients with dyspnea (21.0% vs. 5.3%, p<0.05) at admission. Importantly, in patients presenting with dyspnea the 3month mortality was fourfold higher compared to patients without dyspnea (8.6% vs. 2.1%, p<0.05, OR death: 4.40 95% CI 3.14-6.03). Interestingly, the mortality estimated from the GRACE risk score was below the actual mortality assessed after the 3month follow-up. After adjustment for the GRACE risk score or for heart failure, dyspnea remained highly predictive of death and myocardial infarction within 3months (OR death adjusted for heart failure: 2.99 95% CI 1.99-4.47 and OR death adjusted for GRACE risk score: 3.37 95% CI 2.27-4.99). CONCLUSION: Dyspnea is a common symptom in CPU patients. Our data show that dyspnea is associated with a fourfold higher 3month mortality which is underestimated by the established ACS risk scores. To improve their predictive value we therefore propose to add dyspnea as an item to common risk scores.
BACKGROUND: While dyspnea is a common symptom in patients admitted to Chest Pain Units (CPUs) little is known about the impact of dyspnea on their outcome. The purpose of this study was to evaluate the impact of dyspnea on the short-term outcome of CPU patients. METHODS: We analyzed data from a total of 9169 patients admitted to one of the 38 participating CPUs in this registry between December 2008 and January 2013. Only patients who underwent coronary angiography for suspected ACS were included. 2601 patients (28.4%) presented with dyspnea. RESULTS:Patients with dyspnea at admission were older and frequently had a wide range of comorbidities compared to patients without dyspnea. Heart failure symptoms in particular were more common in patients with dyspnea (21.0% vs. 5.3%, p<0.05) at admission. Importantly, in patients presenting with dyspnea the 3month mortality was fourfold higher compared to patients without dyspnea (8.6% vs. 2.1%, p<0.05, OR death: 4.40 95% CI 3.14-6.03). Interestingly, the mortality estimated from the GRACE risk score was below the actual mortality assessed after the 3month follow-up. After adjustment for the GRACE risk score or for heart failure, dyspnea remained highly predictive of death and myocardial infarction within 3months (OR death adjusted for heart failure: 2.99 95% CI 1.99-4.47 and OR death adjusted for GRACE risk score: 3.37 95% CI 2.27-4.99). CONCLUSION:Dyspnea is a common symptom in CPU patients. Our data show that dyspnea is associated with a fourfold higher 3month mortality which is underestimated by the established ACS risk scores. To improve their predictive value we therefore propose to add dyspnea as an item to common risk scores.
Authors: F Breuckmann; F Remberg; D Böse; M Lichtenberg; P Kümpers; H Pavenstädt; J Waltenberger; D Fischer Journal: Herz Date: 2015-09-25 Impact factor: 1.443
Authors: Rajiv Paudel; Natalia Beridze; Wilbert S Aronow; Chul Ahn; Abdallah Sanaani; Pallak Agarwal; Kim Farell; Diwakar Jain; Robert Timmermans; Howard A Cooper; Julio A Panza Journal: Arch Med Sci Date: 2016-07-01 Impact factor: 3.318