Association between comorbidities and absence of chest pain in acute coronary syndrome with in-hospital outcome.
Por:
Manfrini O, Ricci B, Cenko E, Dorobantu M, Kalpak O, Kedev S, Kneževic B, Koller A, Milicic D, Vasiljevic Z, Badimon L, Bugiardini R
Publicada:
1 ago 2016
Ahead of Print:
28 jun 2016
Resumen:
BACKGROUND: To evaluate the impact of comorbidities on the management and outcomes of acute coronary syndrome (ACS) patients without chest pain/discomfort (i.e. ACS without typical presentation). METHODS: Of the 11,458 ACS patients, enrolled by the International Survey of Acute Coronary Syndrome in Transitional Countries (ISACS-TC; ClinicalTrials.gov: NCT01218776), 8.7% did not have typical presentation at the initial evaluation, and 40.2% had comorbidities. The odds of atypical presentation increased proportionally with the number of comorbidities (odds ratio [OR]: 1, no-comorbid; OR: 1.64, 1 comorbidity; OR: 2.52, 2 comorbidities; OR: 4.57, =3 comorbidities). RESULTS: Stratifying the study population by the presence/absence of comorbidities and typical presentation, we found a decreasing trend for use of medications and percutaneous intervention (OR: 1, typical presentation and no-comorbidities; OR: 0.70, typical presentation and comorbidities; OR: 0.23, atypical presentation and no-comorbidities; OR: 0.18, atypical presentation and comorbidities). On the opposite, compared with patients with typical presentation and no-comorbidities (OR: 1, referent), there was an increasing trend (p<0.001) in the risk of death (OR: 2.00, OR: 2.52 and OR: 4.83) in the above subgroups. However, after adjusting for comorbidities, medications and invasive procedures, atypical presentation was not a predictor of in-hospital death. Independent predictors of poor outcome were history of stroke (OR: 2.04), chronic kidney disease (OR: 1.57), diabetes mellitus (OR: 1.49) and underuse of invasive procedures. CONCLUSIONS: In the ISACS-TC, atypical ACS presentation was often associated with comorbidities. Atypical presentation and comorbidities influenced underuse of in-hospital treatments. The latter and comorbidities are related with poor in-hospital outcome, but not atypical presentation, per se.
Filiaciones:
Manfrini O:
Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
Ricci B:
Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
Cenko E:
Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
Dorobantu M:
Clinical Emergency Hospital Bucharest, Cardiology Department, Bucharest, Romania
Kalpak O:
University Clinic of Cardiology, University "Ss. Cyril and Methodius", Skopje, Macedonia
Kedev S:
University Clinic of Cardiology, University "Ss. Cyril and Methodius", Skopje, Macedonia
Kneževic B:
Clinical Center of Montenegro, Center of Cardiology, Podgorica, Montenegro
Koller A:
Institute of Natural Sciences, University of Physical Education, Budapest, Hungary
Department of Physiology, New York Medical College, Valhalla, NY, USA
Milicic D:
Department for Cardiovascular Diseases, University of Zagreb, Zagreb, Croatia
Vasiljevic Z:
Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
Badimon L:
Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, Institute Carlos III, Autonomous University of Barcelona, Barcelona, Spain
Bugiardini R:
Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
|