Abstract 1102: Atypical Presentation of Acute Coronary Syndrome: The Underestimated High Risk Group. Insights From a Multicenter, Multinational Observational Study
Background: Patients with acute coronary syndrome (ACS) are frequently presented with ischemic chest pain; however a considerable population had atypical presentation. We studied the clinical characteristics and outcomes of patients with atypical presentation across ACS (STEMI, NSTEMI, and unstable angina).
Methods and results: Data were collected from a prospective, multicenter, multinational study over 6 months. Patients with ACS were stratified according to the predominant symptom into; Typical (with ischemic chest pain) and Atypical (without ischemic chest pain) presentation. Patients’ characteristics and in-hospital management and outcomes were compared. We recruited 8,162 patients (76% males) presented with STEMI (39%) and NSTEACS (61%). On admission, 79% patients had typical and 21% patients had atypical presentation. Atypical group’ patients were 6 years older (55 vs 61 ys, p<.001) and had more risk factors for ACS. Age, heart rate (HR), diabetes mellitus (DM), renal failure and Killip class>1 were significant predictors of atypical presentation. This group was significantly less likely to receive evidence-based therapy and experienced significantly worse in-hospital outcomes i.e. heart failure (33.9% vs 11.6%), cardiogenic shock (9.5% vs 4.0%), hospital stay (5.5±0.05 vs 6.0 ±0.13 days, p<0.001) and higher mortality rate (overall ACS 6.9% vs 2.7%, STEMI 18.6% vs 4.5%, NSTEMI 4.2% vs 1.9% and unstable angina 2.4% vs 0.7%.p=0.00). After adjustment for confounders (age, sex, HR, DM, and SBP), atypical presentation was associated with 2-fold increase in mortality (OR 1.9, CI: 1.29 –2.75). Mortality rates were significantly higher in GRACE risk categories in patients with atypical presentation.
Conclusion: Patients with ACS who presented without typical chest pain were frequently underestimated and undertreated. Regardless of the type of ACS, atypical presentation had worse outcomes and needs more attention.