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Presenting heart attack symptoms may help predict outcome

European Society of Cardiology Acute CardioVascular Care 2022
Reuters Health - 21/03/2022 - Patients with non-ST-segment-elevation myocardial infarction (NSTEMI) who report dyspnea or fatigue as their main presenting symptom have a worse prognosis than peers who report chest pain as the predominant feature, a new study suggests.

At one year after NSTEMI, patients with dyspnea or fatigue were less likely to be alive and also less likely to stay out of hospital for heart problems, researchers found.

They presented the study at the European Society of Cardiology (ESC) Acute CardioVascular Care 2022 conference.

Dr. Paulo Medeiros of Braga Hospital, in Portugal, and colleagues analyzed data on 4,726 NSTEMI patients aged 18 and older (71% men; mean age, 68 years). They divided patients into three groups according to their main symptom at presentation.

Chest pain was the most common presenting symptom (91%), followed by dyspnea/fatigue (7%) and syncope (2%).

Patients with dyspnea/fatigue were significantly older than peers in other two groups (mean age, 75 vs. 68 in the chest pain group and 74 years in the syncope group).

Patients with dyspnea/fatigue were also more likely to women (42%) compared to peers with chest pain as the main symptom (29% women) or syncope (37% women).

Patients with dyspnea/fatigue as their main symptom were also significantly more likely to have hypertension, diabetes, chronic kidney disease and chronic obstructive pulmonary disease (COPD). They also had worse Killip class at hospital admission.

The one-year survival rate (primary outcome) was lowest in NSTEMI patients who presented with dyspnea/fatigue (76%) compared with those presenting with chest pain (94%) or syncope (92%).

The one-year free from cardiovascular readmission was also lowest in the dyspnea/fatigue group (76% vs. 85% and 83%, respectively), according to the conference abstract.

However, in multivariate analysis adjusted for COPD, atrial fibrillation, left ventricular ejection fraction, major bleeding, and ventricular tachycardia, none of the symptoms emerged as independent predictors of one-year survival.

"Shortness of breath was more common among patients that died during the year after their heart attack. However, when considering all of the studied variables, the type of presenting symptom was not an independent predictor of mortality, meaning that we cannot specifically state that shortness of breath was the reason for the worse outcome," Dr. Medeiros said in a conference statement.

"Poorer survival may be due to other factors in those patients, such as reduced heart pump function," he noted.

Nonetheless, this study "highlights the need to consider a diagnosis of myocardial infarction even when the primary complaint is not chest pain. This may be particularly important for women and older patients where diagnosis could be delayed and result in worse outcomes," Dr. Medeiros said.

"In addition to the classic heart attack symptom of chest pain, pressure, or heaviness radiating to one or both arms, the neck or jaw, people should seek urgent medical help if they experience prolonged shortness of breath," he added.

SOURCE: https://bit.ly/3qhg2bX European Society of Cardiology Acute CardioVascular Care 2022, March 18-20, 2022.

By Reuters Staff

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