Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: Insights from The Global Registry of Acute Coronary Events
Identifieur interne : 00AD92 ( Main/Exploration ); précédent : 00AD91; suivant : 00AD93Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: Insights from The Global Registry of Acute Coronary Events
Auteurs : David Brieger [Australie] ; Kim A. Eagle [États-Unis] ; Shaun G. Goodman [Canada] ; P. Gabriel Steg [France] ; Andrzej Budaj [Pologne] ; Kami White [États-Unis] ; Gilles Montalescot [France]Source :
- Chest [ 0012-3692 ] ; 2004.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
Abstract
Study objectives: The clinical manifestations of acute coronary syndromes (ACSs) vary, and patients present frequently with symptoms other than chest pain. In this analysis, a large contemporary database has been accessed to define the frequency, clinical characteristics, and outcomes of patients presenting without chest pain across different diagnostic categories of ACS. Design and setting: The Global Registry of Acute Coronary Events is a multinational, prospective, observational study involving 14 countries. Patients: Patients presenting to the hospital with a suspected ACS were stratified according to whether their predominant presenting symptoms included chest pain (ie, typical) or did not (ie, atypical). Demographics, medical history, hospital management, and outcomes were compared. Measurements and results: Of the 20,881 patients in this analysis, 1,763 (8.4%) presented without chest pain, 23.8% of whom were not initially recognized as having an ACS. They were less likely to receive effective cardiac medications, and experienced greater hospital morbidity and I mortality (13% vs 4.3%, respectively; p < 0.0001) than did patients with typical symptoms. After adjusting for potentially confounding variables, increased hospital mortality rates were noted in patients with dominant presenting symptoms of presyncope/spcope (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.4 to 2.9), nausea or vomiting (OR, 1.6; 95% CI, 1.1 to 2.4), and dyspnea (OR, 1.4; 95% CI, 1.1 to 1.9), and in those with painless presentations of unstable angina (OR, 2.2; 95% CI, 1.4 to 3.5) and ST-segment elevation myocardial infarction (OR, 1.7; 95% CI, 1.2 to 2.2). Conclusion: Patients with ACSs who present without chest pain are frequently misdiagnosed and undertreated. With the exception of diaphoresis, each dominant presenting symptom independently identifies a population that is at increased risk of dying. These patients experience greater morbidity and a higher mortality across the spectrum of ACSs.
Affiliations:
- Australie, Canada, France, Pologne, États-Unis
- Nouvelle-Galles du Sud, Ontario, Île-de-France
- Paris, Sydney, Toronto
- Université de Sydney, Université de Toronto
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Eagle</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Michigan Health System</s1><s2>Ann Arbor, MI</s2><s3>USA</s3><sZ>2 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of Michigan Health System</wicri:noRegion></affiliation></author><author><name sortKey="Goodman, Shaun G" sort="Goodman, Shaun G" uniqKey="Goodman S" first="Shaun G." last="Goodman">Shaun G. Goodman</name><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Canadian Heart Research Centre and Terrence Donnelly Heart Center, Division of Cardiology St. Michael's Hospital, University of Toronto</s1><s2>Toronto, ON</s2><s3>CAN</s3><sZ>3 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Steg, P Gabriel" sort="Steg, P Gabriel" uniqKey="Steg P" first="P. 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Eagle</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Michigan Health System</s1><s2>Ann Arbor, MI</s2><s3>USA</s3><sZ>2 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of Michigan Health System</wicri:noRegion></affiliation></author><author><name sortKey="Goodman, Shaun G" sort="Goodman, Shaun G" uniqKey="Goodman S" first="Shaun G." last="Goodman">Shaun G. Goodman</name><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Canadian Heart Research Centre and Terrence Donnelly Heart Center, Division of Cardiology St. Michael's Hospital, University of Toronto</s1><s2>Toronto, ON</s2><s3>CAN</s3><sZ>3 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Steg, P Gabriel" sort="Steg, P Gabriel" uniqKey="Steg P" first="P. Gabriel" last="Steg">P. Gabriel Steg</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Hôpital Bichat</s1><s2>Paris</s2><s3>FRA</s3><sZ>4 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Budaj, Andrzej" sort="Budaj, Andrzej" uniqKey="Budaj A" first="Andrzej" last="Budaj">Andrzej Budaj</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Grochowski Hospital</s1><s2>Warsaw</s2><s3>POL</s3><sZ>5 aut.</sZ></inist:fA14><country>Pologne</country><wicri:noRegion>Grochowski Hospital</wicri:noRegion></affiliation></author><author><name sortKey="White, Kami" sort="White, Kami" uniqKey="White K" first="Kami" last="White">Kami White</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>University of Massa chusetts Medical School</s1><s2>Worcester, MA</s2><s3>USA</s3><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of Massa chusetts Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Montalescot, Gilles" sort="Montalescot, Gilles" uniqKey="Montalescot G" first="Gilles" last="Montalescot">Gilles Montalescot</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Pitié-Salpêtrière Hospital</s1><s2>Paris</s2><s3>FRA</s3><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author></analytic><series><title level="j" type="main">Chest</title><title level="j" type="abbreviated">Chest</title><idno type="ISSN">0012-3692</idno><imprint><date when="2004">2004</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Chest</title><title level="j" type="abbreviated">Chest</title><idno type="ISSN">0012-3692</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Acute</term><term>Acute chest syndrome</term><term>Anesthesia</term><term>Atypical</term><term>Cardiology</term><term>Circulatory system</term><term>Coronary artery</term><term>Coronary heart disease</term><term>Evolution</term><term>High risk</term><term>Pain</term><term>Prognosis</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Syndrome thoracique aigu</term><term>Artère coronaire</term><term>Douleur</term><term>Cardiopathie coronaire</term><term>Risque élevé</term><term>Aigu</term><term>Atypique</term><term>Pronostic</term><term>Evolution</term><term>Anesthésie</term><term>Appareil circulatoire</term><term>Cardiologie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Study objectives: The clinical manifestations of acute coronary syndromes (ACSs) vary, and patients present frequently with symptoms other than chest pain. In this analysis, a large contemporary database has been accessed to define the frequency, clinical characteristics, and outcomes of patients presenting without chest pain across different diagnostic categories of ACS. Design and setting: The Global Registry of Acute Coronary Events is a multinational, prospective, observational study involving 14 countries. Patients: Patients presenting to the hospital with a suspected ACS were stratified according to whether their predominant presenting symptoms included chest pain (ie, typical) or did not (ie, atypical). Demographics, medical history, hospital management, and outcomes were compared. Measurements and results: Of the 20,881 patients in this analysis, 1,763 (8.4%) presented without chest pain, 23.8% of whom were not initially recognized as having an ACS. They were less likely to receive effective cardiac medications, and experienced greater hospital morbidity and I mortality (13% vs 4.3%, respectively; p < 0.0001) than did patients with typical symptoms. After adjusting for potentially confounding variables, increased hospital mortality rates were noted in patients with dominant presenting symptoms of presyncope/spcope (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.4 to 2.9), nausea or vomiting (OR, 1.6; 95% CI, 1.1 to 2.4), and dyspnea (OR, 1.4; 95% CI, 1.1 to 1.9), and in those with painless presentations of unstable angina (OR, 2.2; 95% CI, 1.4 to 3.5) and ST-segment elevation myocardial infarction (OR, 1.7; 95% CI, 1.2 to 2.2). Conclusion: Patients with ACSs who present without chest pain are frequently misdiagnosed and undertreated. With the exception of diaphoresis, each dominant presenting symptom independently identifies a population that is at increased risk of dying. These patients experience greater morbidity and a higher mortality across the spectrum of ACSs.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Canada</li><li>France</li><li>Pologne</li><li>États-Unis</li></country><region><li>Nouvelle-Galles du Sud</li><li>Ontario</li><li>Île-de-France</li></region><settlement><li>Paris</li><li>Sydney</li><li>Toronto</li></settlement><orgName><li>Université de Sydney</li><li>Université de Toronto</li></orgName></list><tree><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Brieger, David" sort="Brieger, David" uniqKey="Brieger D" first="David" last="Brieger">David Brieger</name></region></country><country name="États-Unis"><noRegion><name sortKey="Eagle, Kim A" sort="Eagle, Kim A" uniqKey="Eagle K" first="Kim A." last="Eagle">Kim A. Eagle</name></noRegion><name sortKey="White, Kami" sort="White, Kami" uniqKey="White K" first="Kami" last="White">Kami White</name></country><country name="Canada"><region name="Ontario"><name sortKey="Goodman, Shaun G" sort="Goodman, Shaun G" uniqKey="Goodman S" first="Shaun G." last="Goodman">Shaun G. Goodman</name></region></country><country name="France"><region name="Île-de-France"><name sortKey="Steg, P Gabriel" sort="Steg, P Gabriel" uniqKey="Steg P" first="P. Gabriel" last="Steg">P. Gabriel Steg</name></region><name sortKey="Montalescot, Gilles" sort="Montalescot, Gilles" uniqKey="Montalescot G" first="Gilles" last="Montalescot">Gilles Montalescot</name></country><country name="Pologne"><noRegion><name sortKey="Budaj, Andrzej" sort="Budaj, Andrzej" uniqKey="Budaj A" first="Andrzej" last="Budaj">Andrzej Budaj</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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