Clinical signs of pulmonary congestion predict outcome in patients with acute chest pain.
BACKGROUND
Pulmonary congestion is associated with poor outcome in patients with acute coronary syndromes. In consecutive patients presenting with acute unexplained chest pain to a primary care facility, the prognostic impact of pulmonary congestion is indeterminate. Therefore, we assessed the predictive value of clinical signs of pulmonary congestion in patients presenting with acute chest pain to an emergency department with regard to the origin of the symptoms.


METHODS
1288 consecutive patients with acute chest pain were prospectively assessed for clinical signs of pulmonary congestion. The diagnosis was confirmed by chest radiography. The association of pulmonary congestion and short- and intermediate-term mortality in patients with coronary (n = 381) and non-coronary (n = 907) causes of chest pain was determined using multivariate Cox regression analysis.


RESULTS
108 (8%) patients had clinical signs of pulmonary congestion. Within the mean follow-up period of 23 months (SD 4) 67 patients died, mainly within the first 6 months. Of 108 patients with pulmonary congestion, 82 (76%) had coronary and 26 (24%) had non-coronary chest pain. Pulmonary congestion was independently associated with mortality in patients with coronary chest pain (hazard ratio 6.4, 95% confidence interval 2.5 to 16.1, p < 0.0001), both in patients with acute coronary syndromes or angina pectoris. However, in patients with non-coronary chest pain we observed no independent association of pulmonary congestion with outcome.


CONCLUSIONS
Clinical signs of pulmonary congestion indicate an increased risk for poor outcome in patients with chest pain due to myocardial ischemia. Mortality of these patients is high, particularly in the first months after presentation. Therefore, hospital admission is warranted, including patients with angina pectoris, who otherwise may be candidates for early discharge.
Schillinger
Martin
M
Department of Angiology, University of Vienna, Medical Faculty, Vienna, Austria. martin.schillinger@akh-wien.ac.at
Domanovits
Hans
H
Paulis
Monika
M
Nikfardjam
Mariam
M
Meron
Giora
G
Kurkciyan
Istepan
I
Laggner
Anton N
AN
D000208:Acute Disease; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000401:mortality; D002637:Chest Pain / Q000209:etiology* / Q000401:mortality; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D003627:Data Interpretation, Statistical; D004417:Dyspnea / Q000175:diagnosis; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis; D006760:Hospitalization; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000175:diagnosis; D013902:Radiography, Thoracic; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome