Author + information
- Jose A. Barrabes,
- Alfredo Bardaji,
- Javier Jiménez-Candil,
- Vicente Bodí,
- Roman Freixa,
- Rafael Vazquez,
- Jesus-Gabriel Sánchez-Ramos,
- Andrés May,
- Maria-Jesús Rollán and
- Antonio Fernandez-Ortiz
Background: The population of patients hospitalized with suspected acute coronary syndrome (ACS) in whom the diagnosis is not confirmed is not well characterized.
Methods: In a nationwide contemporary registry of consecutive patients hospitalized for suspected ACS in 44 randomly selected hospitals, we assessed admission characteristics and in-hospital and 6-month mortality (vital status known in 97.2%) of patients discharged with other diagnoses and compared this subgroup with true ACS patients.
Results: Of 2,557 patients, 9.0% had a non-ACS diagnosis at discharge: 6.2% non-specific chest pain and 2.8% other diagnoses (stress cardiomyopathy, myocardial or valvular disease, heart failure, arrhythmia, lung disease or others). Compared with true ACS patients, those with other diagnoses were younger (64±14 vs 68±13 years, respectively, P<0.001), more often female (35.9 vs 24.6%, P<0.001) and had less cardiovascular risk factors. They had similar rates of non-chest pain presentation (11.7 vs 8.7%, P=NS) and similar heart rate, systolic blood pressure and frequency of Killip class III/IV on admission as true ACS patients. Rates of sinus rhythm were comparable but non-ACS patients more frequently presented with a normal QRS (73.6 vs 67.5%, P<0.001) and without ST deviation (47.6 vs 22.0%, P<0.001) and they had lower rates of persistent ST elevation (7.4 vs 33.2%, P<0.001) and a lower GRACE score (119±38 vs 140±39, P<0.001) than true ACS patients. In-hospital (4.3 vs 4.0%, respectively, P=0.834) and 6-month (5.4 vs 8.0%, P=0.163) mortality rates were similar in both groups. However, if the non-ACS group were divided into subgroups with non-specific chest pain or other diagnoses, major differences in in-hospital (0.0 vs 13.9%, respectively, P<0.001) and 6-month (0.7 vs 15.7%, P<0.001) mortality rates would become apparent.
Conclusions: Prognosis of patients hospitalized with suspected ACS in whom the diagnosis is not confirmed follows a bimodal pattern, being excellent in those with non-specific chest pain but worse than that of patients with true ACS in the remaining patients. Efforts are still needed to ensure prompt identification of these patients allowing appropriate management decisions.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Acute Coronary Syndromes, Diagnosis, Management and Outcomes
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1253-349
- 2017 American College of Cardiology Foundation