Association of accompanying dyspnoea with diagnosis and outcome of patients presenting with acute chest discomfort-Reference-Cited by-同舟云学术

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

Published:2023-03-14 Issue:5 Volume:12 Page:283-295
ISSN:2048-8726
Container-title:European Heart Journal: Acute Cardiovascular Care
language:en
Short-container-title:

Author:

Boeddinghaus Jasper¹²³^ORCID,Nestelberger Thomas¹²^ORCID,Koechlin Luca¹²⁴^ORCID,Lopez-Ayala Pedro¹²^ORCID,Wussler Desiree¹²⁵^ORCID,Mais Maximilian¹,Zwimpfer Luca¹^ORCID,Zimmermann Tobias¹²⁶^ORCID,Wildi Karin¹²⁷,Giménez Maria Rubini¹²⁸^ORCID,Strebel Ivo¹²,Miró Òscar²⁹,Martin-Sanchez F Javier²¹⁰,Parenica Jiri¹¹,Keller Dagmar I¹²,Gualandro Danielle M¹²,Nickel Christian H¹³,Bingisser Roland¹³,Christ Michael¹⁴,Mueller Christian¹²^ORCID,

Affiliation:

1. Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel , Petersgraben 4, CH-4031 Basel , Switzerland

2. GREAT network , Rome , Italy

3. BHF Centre for Cardiovascular Science, University of Edinburgh , Scotland , United Kingdom

4. Department of Cardiac Surgery, University Hospital Basel, University of Basel , Switzerland

5. Division of Internal Medicine, University Hospital Basel, University of Basel , Switzerland

6. Department of Intensive Care Medicine, University Hospital Basel, University of Basel , Basel , Switzerland

7. Critical Care Research Group, The Prince Charles Hospital, Brisbane and the University of Queensland , Brisbane , Australia

8. Leipzig Heart Center , Leipzig , Germany

9. Emergency Department, Hospital Clinic , Barcelona, Catalonia , Spain

10. Servicio de Urgencias, Hospital Clínico San Carlos , Madrid , Spain

11. Department of Cardiology, University Hospital Brno, Brno, Czech Republic and Medical Faculty, Masaryk University , Brno , Czech Republic

12. Emergency Department, University Hospital Zurich , Zurich , Switzerland

13. Emergency Department, University Hospital Basel, University of Basel , Switzerland

14. Emergency Department, Kantonsspital Luzern , Switzerland

Abstract

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

Funder

Swiss National Science Foundation

Swiss Heart Foundation

KTI

European Union

University of Basel

University Hospital Basel

Abbott

Beckman Coulter

Biomerieux

Idorsia

Ortho Cinical Diagnostics