Degree of dyspnoea in patients with non-ST-elevation acute coronary syndrome: A report from Japanese multicenter registry

Yasuyuki Shiraishi, Shun Kosaka, Ikuko Ueda, Taku Inohara, Mitsuaki Sawano, Yohei Numasawa, Kentaro Hayashida, Yuichiro Maekawa, Yukihiko Momiyama, Keiichi Fukuda

Research output: Contribution to journalArticle

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Abstract

Background: Degree of dyspnoea is almost universally evaluated in the patients presenting with acute coronary syndrome (ACS), but its clinical implications has not been thoroughly investigated. We aimed to describe the relationship between the severity of dyspnoea and in-hospital outcomes in patients with non-ST elevation ACS (NSTE-ACS) complicated with acute heart failure (AHF). Methods: Between 2009 and 2014, 3287 consecutive patients with NSTE-ACS were enrolled in the Japanese prospective multicenter PCI registry. Patients complicated with AHF were subclassified based on the self-reported dyspnoea severity: no dyspnoeic symptoms, dyspnoea during moderate activity, mild activity or at rest. The recorded outcomes included in-hospital death, major cardiovascular (ie, cardiac death, shock, stroke or major bleeding) and renal events (ie, contrast-induced acute kidney injury [CI-AKI] or AKI requiring dialysis). Results: In total, 441 (13.4%) patients had AHF upon presentation, including 76 (17.2%) with dyspnoea during moderate activity, 160 (36.3%) with dyspnoea during mild activity, and 205 (46.5%) with dyspnoea at rest. In-hospital mortality as well as major cardiovascular and renal events increased as dyspnoea severity worsened. After multivariate adjustment, dyspnoea at rest was strongly associated with in-hospital mortality (odds ratio [OR] 5.79; 95% confidence interval [CI], 2.56-13.11; P<.001) as well as major cardiovascular (OR, 2.55; 95% CI, 1.46-4.48; P<.001) and renal events (OR, 3.32; 95% CI, 2.05-5.38; P<.001), when compared to the patients without dyspnoea. Conclusions: Among NSTE-ACS patients complicated with AHF, both cardiovascular and renal event rates were associated with presence of dyspnoea, and its incidence increased in parallel with dyspnoea severity.

Original languageEnglish
Pages (from-to)978-987
Number of pages10
JournalInternational Journal of Clinical Practice
Volume70
Issue number12
DOIs
Publication statusPublished - 2016 Dec 1

Fingerprint

Acute Coronary Syndrome
Dyspnea
Registries
Heart Failure
Kidney
Odds Ratio
Confidence Intervals
Hospital Mortality
Acute Kidney Injury
Dialysis
Shock
Stroke
Hemorrhage

Keywords

  • acute heart failure
  • dyspnoea
  • non–ST-elevation acute coronary syndrome
  • risk stratification

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Degree of dyspnoea in patients with non-ST-elevation acute coronary syndrome : A report from Japanese multicenter registry. / Shiraishi, Yasuyuki; Kosaka, Shun; Ueda, Ikuko; Inohara, Taku; Sawano, Mitsuaki; Numasawa, Yohei; Hayashida, Kentaro; Maekawa, Yuichiro; Momiyama, Yukihiko; Fukuda, Keiichi.

In: International Journal of Clinical Practice, Vol. 70, No. 12, 01.12.2016, p. 978-987.

Research output: Contribution to journalArticle

Shiraishi, Yasuyuki ; Kosaka, Shun ; Ueda, Ikuko ; Inohara, Taku ; Sawano, Mitsuaki ; Numasawa, Yohei ; Hayashida, Kentaro ; Maekawa, Yuichiro ; Momiyama, Yukihiko ; Fukuda, Keiichi. / Degree of dyspnoea in patients with non-ST-elevation acute coronary syndrome : A report from Japanese multicenter registry. In: International Journal of Clinical Practice. 2016 ; Vol. 70, No. 12. pp. 978-987.
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abstract = "Background: Degree of dyspnoea is almost universally evaluated in the patients presenting with acute coronary syndrome (ACS), but its clinical implications has not been thoroughly investigated. We aimed to describe the relationship between the severity of dyspnoea and in-hospital outcomes in patients with non-ST elevation ACS (NSTE-ACS) complicated with acute heart failure (AHF). Methods: Between 2009 and 2014, 3287 consecutive patients with NSTE-ACS were enrolled in the Japanese prospective multicenter PCI registry. Patients complicated with AHF were subclassified based on the self-reported dyspnoea severity: no dyspnoeic symptoms, dyspnoea during moderate activity, mild activity or at rest. The recorded outcomes included in-hospital death, major cardiovascular (ie, cardiac death, shock, stroke or major bleeding) and renal events (ie, contrast-induced acute kidney injury [CI-AKI] or AKI requiring dialysis). Results: In total, 441 (13.4{\%}) patients had AHF upon presentation, including 76 (17.2{\%}) with dyspnoea during moderate activity, 160 (36.3{\%}) with dyspnoea during mild activity, and 205 (46.5{\%}) with dyspnoea at rest. In-hospital mortality as well as major cardiovascular and renal events increased as dyspnoea severity worsened. After multivariate adjustment, dyspnoea at rest was strongly associated with in-hospital mortality (odds ratio [OR] 5.79; 95{\%} confidence interval [CI], 2.56-13.11; P<.001) as well as major cardiovascular (OR, 2.55; 95{\%} CI, 1.46-4.48; P<.001) and renal events (OR, 3.32; 95{\%} CI, 2.05-5.38; P<.001), when compared to the patients without dyspnoea. Conclusions: Among NSTE-ACS patients complicated with AHF, both cardiovascular and renal event rates were associated with presence of dyspnoea, and its incidence increased in parallel with dyspnoea severity.",
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T1 - Degree of dyspnoea in patients with non-ST-elevation acute coronary syndrome

T2 - A report from Japanese multicenter registry

AU - Shiraishi, Yasuyuki

AU - Kosaka, Shun

AU - Ueda, Ikuko

AU - Inohara, Taku

AU - Sawano, Mitsuaki

AU - Numasawa, Yohei

AU - Hayashida, Kentaro

AU - Maekawa, Yuichiro

AU - Momiyama, Yukihiko

AU - Fukuda, Keiichi

PY - 2016/12/1

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N2 - Background: Degree of dyspnoea is almost universally evaluated in the patients presenting with acute coronary syndrome (ACS), but its clinical implications has not been thoroughly investigated. We aimed to describe the relationship between the severity of dyspnoea and in-hospital outcomes in patients with non-ST elevation ACS (NSTE-ACS) complicated with acute heart failure (AHF). Methods: Between 2009 and 2014, 3287 consecutive patients with NSTE-ACS were enrolled in the Japanese prospective multicenter PCI registry. Patients complicated with AHF were subclassified based on the self-reported dyspnoea severity: no dyspnoeic symptoms, dyspnoea during moderate activity, mild activity or at rest. The recorded outcomes included in-hospital death, major cardiovascular (ie, cardiac death, shock, stroke or major bleeding) and renal events (ie, contrast-induced acute kidney injury [CI-AKI] or AKI requiring dialysis). Results: In total, 441 (13.4%) patients had AHF upon presentation, including 76 (17.2%) with dyspnoea during moderate activity, 160 (36.3%) with dyspnoea during mild activity, and 205 (46.5%) with dyspnoea at rest. In-hospital mortality as well as major cardiovascular and renal events increased as dyspnoea severity worsened. After multivariate adjustment, dyspnoea at rest was strongly associated with in-hospital mortality (odds ratio [OR] 5.79; 95% confidence interval [CI], 2.56-13.11; P<.001) as well as major cardiovascular (OR, 2.55; 95% CI, 1.46-4.48; P<.001) and renal events (OR, 3.32; 95% CI, 2.05-5.38; P<.001), when compared to the patients without dyspnoea. Conclusions: Among NSTE-ACS patients complicated with AHF, both cardiovascular and renal event rates were associated with presence of dyspnoea, and its incidence increased in parallel with dyspnoea severity.

AB - Background: Degree of dyspnoea is almost universally evaluated in the patients presenting with acute coronary syndrome (ACS), but its clinical implications has not been thoroughly investigated. We aimed to describe the relationship between the severity of dyspnoea and in-hospital outcomes in patients with non-ST elevation ACS (NSTE-ACS) complicated with acute heart failure (AHF). Methods: Between 2009 and 2014, 3287 consecutive patients with NSTE-ACS were enrolled in the Japanese prospective multicenter PCI registry. Patients complicated with AHF were subclassified based on the self-reported dyspnoea severity: no dyspnoeic symptoms, dyspnoea during moderate activity, mild activity or at rest. The recorded outcomes included in-hospital death, major cardiovascular (ie, cardiac death, shock, stroke or major bleeding) and renal events (ie, contrast-induced acute kidney injury [CI-AKI] or AKI requiring dialysis). Results: In total, 441 (13.4%) patients had AHF upon presentation, including 76 (17.2%) with dyspnoea during moderate activity, 160 (36.3%) with dyspnoea during mild activity, and 205 (46.5%) with dyspnoea at rest. In-hospital mortality as well as major cardiovascular and renal events increased as dyspnoea severity worsened. After multivariate adjustment, dyspnoea at rest was strongly associated with in-hospital mortality (odds ratio [OR] 5.79; 95% confidence interval [CI], 2.56-13.11; P<.001) as well as major cardiovascular (OR, 2.55; 95% CI, 1.46-4.48; P<.001) and renal events (OR, 3.32; 95% CI, 2.05-5.38; P<.001), when compared to the patients without dyspnoea. Conclusions: Among NSTE-ACS patients complicated with AHF, both cardiovascular and renal event rates were associated with presence of dyspnoea, and its incidence increased in parallel with dyspnoea severity.

KW - acute heart failure

KW - dyspnoea

KW - non–ST-elevation acute coronary syndrome

KW - risk stratification

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