Shortness of breath, fatigue may signal worse outcomes after non-STEMI
Click Here to Manage Email Alerts
In adults with non-STEMI, those presenting with shortness of breath or fatigue were more likely to die or be readmitted for CV complications at 1 year compared with those presenting with chest pain, researchers reported.
In a database analysis, researchers found that just 76% of patients who experienced non-STEMI with dyspnea or fatigue as their main symptom were alive at 1 year compared with 94% of those with chest pain as the predominant feature, though the symptoms were not independent predictors of 1-year mortality. The data were presented at ESC Acute CardioVascular Care Congress 2022, a scientific congress of the European Society of Cardiology.
The most common clinical presentation of non-STEMI is angina; however, some groups such as older adults, women and those with chronic conditions may have atypical symptoms like isolated dyspnea or syncope, Paulo Medeiros, MD, of Braga Hospital, Portugal, said during a presentation.
“Patients with acute myocardial infarction may present with symptoms other than chest pain, such as shortness of breath, syncope or abdominal pain. It is crucial to be aware of these various manifestations to make sure this diagnosis is not missed,” Medeiros told Healio. “In our study, patients presenting with dyspnea had an overall worse prognosis, with higher 1-year mortality and hospitalization due to CV causes. However, symptoms themselves were not independent predictors of the studied outcomes. Identified predictors included left ventricular ejection fraction, chronic obstructive pulmonary disease, sustained ventricular tachycardia and major bleeding.”
Presenting symptoms, patient characteristics
In a retrospective study, Medeiros and colleagues analyzed data from 4,726 adults admitted with non-STEMI from October 2010 to September 2019, using data from the Portuguese Registry of Acute Coronary Syndromes. The mean age of patients was 68 years and 71% were men. Researchers stratified patients according to main symptom at presentation: chest pain (91%), dyspnea/fatigue (7%) and syncope (2%). The primary endpoint was all-cause mortality at 1 year; the secondary endpoint was CV hospitalization at 1 year.
Researchers found patients presenting with dyspnea/fatigue were older compared with patients who presented with chest pain or syncope (mean age, 75 years vs. 68 years and 74 years, respectively) and were more likely to be women (42% vs. 29% and 37%, respectively). Those presenting with dyspnea/fatigue were also more likely to have hypertension, diabetes, chronic kidney disease and chronic obstructive pulmonary disease (COPD).
Survival, readmission rates
Comparing survival rates, 76% of patients in the dyspnea/fatigue group were alive 1 year after non-STEMI compared with 94% of the chest pain group and 92% of the syncope group. During the year after non-STEMI, 24% of patients in the dyspnea/fatigue group were readmitted for CV causes vs. 15% of the chest pain group and 17% of the syncope group.
“Patients presenting with shortness of breath or fatigue had a worse prognosis than those with chest pain,” Medeiros said in the release. “They were less likely to be alive 1 year after their heart attack and also less likely to stay out of hospital for heart problems during that 12-month period.”
However, researchers found that none of chest pain, dyspnea/fatigue or syncope were independent predictors of 1-year survival in analyses adjusted for age, COPD, atrial fibrillation, left ventricular ejection fraction, major bleeding and ventricular tachycardia.
Medeiros said poorer survival among patients reporting shortness of breath or fatigue may be due to other factors.
“We still lack a risk stratification model that improves clinical outcomes,” Medeiros told Healio. “It is unclear if the current multivariable risk prediction models do so. Also, we need dedicated trials for the pharmacological and invasive management of these patients to better understand how to improve their clinical status and outcomes.”
Collapse
Medeiros P, et al. Abstract 20248. Presented at: ESC Acute CardioVascular Care Congress 2022; March 18-19, 2022 (virtual meeting).
Read more about
Click Here to Manage Email Alerts