Association between comorbidities and absence of chest pain in acute coronary syndrome with in-hospital outcome

Int J Cardiol. 2016 Aug:217 Suppl:S37-43. doi: 10.1016/j.ijcard.2016.06.221. Epub 2016 Jun 28.

Abstract

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.

Keywords: Acute coronary syndrome; Chest pain; Chronic kidney disease; Comorbidity; Heart failure; Stroke.

Publication types

  • Clinical Trial

MeSH terms

  • Acute Coronary Syndrome / therapy*
  • Aged
  • Aged, 80 and over
  • Cardiovascular Agents / therapeutic use*
  • Chest Pain / etiology*
  • Comorbidity
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Percutaneous Coronary Intervention / statistics & numerical data*
  • Registries
  • Risk Factors

Substances

  • Cardiovascular Agents

Associated data

  • ClinicalTrials.gov/NCT01218776