Dyspnoea exacerbates outcomes in acute coronary syndrome

Acute coronary syndrome (ACS) patients without heart failure but with dyspnoea appear to suffer from worse outcomes, a new study has found.

Researchers conducted a retrospective comparative analysis on ACS patients, of whom 2,017 (mean age, 61.8±12 years; 75 percent female) had chest pain alone and 417 (mean age, 64.4±13 years; 81 percent female) had both chest pain and dyspnoea.

Aside from differences in age and sex, participants with dyspnoea were more likely to have diabetes, chronic kidney disease and chronic heart failure. These factors, along with chronic obstructive pulmonary disease, and with the exception of congestive heart failure, were also found to be predictors of dyspnoea.

Patients with dyspnoea suffered from worse outcomes. Thirty-day mortality rates, for instance, were higher among these participants than in their chest pain-only comparators (3 percent vs 2 percent; p=0.017). This trend persisted over time, such that the 1-year mortality risk estimates remained higher in those with dyspnoea (9 percent vs 4 percent; p<0.001).

Multivariant analysis confirmed the role of dyspnoea on mortality risk (hazard ratio, 1.6, 95 percent confidence interval [CI], 1.03–2.5; p=0.0316).

A similar pattern was observed for the rate of in-hospital complications, which occurred 34-percent more frequently in the dyspnoea participants. There was likewise an excess in the likelihood of progression to overt heart failure in the dyspnoea group (11 percent vs 6 percent; p<0.001). Moreover, among those who underwent coronary angiography, three-vessel coronary artery disease was more common among those with dyspnoea.