Outcomes worse for patients with atypical acute coronary syndrome

Atypical presentation of acute coronary syndrome (ACS) appears to be correlated with worse outcomes, a new study has found.

The study included 14,722 ACS patients, of whom 11,508 (mean age, 62.9 ±12.7 years; 21.3 percent female) presented with the typical chest pain; the remaining 3,214 (21 percent; mean age, 66.8±13.3 years; 29.0 percent female) had atypical primary complaints, such as dyspnoea or palpitations. Mortality was set as a study outcome.

Those who presented with atypical complaints were more likely to be older, female, and have more comorbidities like hypertension and renal dysfunction. This group was also more likely to have non-ST elevation ACS and experienced greater delays in primary assessment.

Intervention delivery was likewise asymmetric between the two groups. Those with atypical presentations received coronary angiography less frequently and, in turn, had lower rates of percutaneous coronary intervention.

Outcomes for the atypically presenting group were likewise worse. Thirty-day mortality, for instance, was significantly higher in this group as opposed to their counterparts with typical complaints (7.7 percent vs 3.6 percent; p<0.001). Prolonging the time frame of estimation to 1 year did not change the findings (15.6 percent vs 7.5 percent; p<0.001).

Similarly, the rate of occurrence of major adverse cardiovascular events within 30 days was significantly elevated in those with atypical complaints (18 percent vs 13.5 percent; p<0.001).

These were confirmed by Cox regression analysis, which found that typical chest pain presentation was significantly but inversely correlated with 1-year mortality risk (hazard ratio, 0.73, 95 percent confidence interval, 0.65–0.82).