Key result
Dyspnoea with acute chest discomfort is linked to ~81% higher two-year mortality despite similar MI rates.
Why the study?
The association of accompanying dyspnoea with differential diagnoses, diagnostic work-up, and outcomes in patients presenting with acute chest pain/discomfort was unclear.
Does accompanying dyspnoea predict specific diagnoses and long-term mortality in patients presenting with acute chest discomfort?
Cohort (n=6,045)
Does accompanying dyspnoea predict specific diagnoses and long-term mortality in patients presenting with acute chest discomfort?
Absolute Event Rate: 22.4% vs 21.9%
p-value: p=0.60
In patients presenting to the emergency department with acute chest discomfort, accompanying dyspnoea does not increase the likelihood of acute coronary syndrome but is a strong independent predictor of 2-year mortality and cardiac non-coronary disease.
Accompanying dyspnoea signals higher 2-year mortality without altering ACS prevalence or hs-cTn rule-out safety; leaves open targeted evaluation of non-coronary cardiac disease.
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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Boeddinghaus et al. (2023) conducted a cohort in Acute chest pain/discomfort (n=6,045). Accompanying dyspnoea vs. No accompanying dyspnoea was evaluated on Final diagnosis of myocardial infarction (p=0.60). Accompanying dyspnoea in acute chest discomfort was not associated with more MI (22.4% vs 21.9%) but independently predicted death at 2 years (HR 1.813; 95% CI 1.453-2.261).
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