title: The German CPU Registry: Dyspnea independently predicts negative short-term outcome in patients admitted to German Chest Pain Units.
abstract: BACKGROUND
  While dyspnea is a common symptom in patients admitted to Chest Pain Units (CPUs) little is known about the impact of dyspnea on their outcome. The purpose of this study was to evaluate the impact of dyspnea on the short-term outcome of CPU patients.
  
  
  METHODS
  We analyzed data from a total of 9169 patients admitted to one of the 38 participating CPUs in this registry between December 2008 and January 2013. Only patients who underwent coronary angiography for suspected ACS were included. 2601 patients (28.4%) presented with dyspnea.
  
  
  RESULTS
  Patients with dyspnea at admission were older and frequently had a wide range of comorbidities compared to patients without dyspnea. Heart failure symptoms in particular were more common in patients with dyspnea (21.0% vs. 5.3%, p<0.05) at admission. Importantly, in patients presenting with dyspnea the 3month mortality was fourfold higher compared to patients without dyspnea (8.6% vs. 2.1%, p<0.05, OR death: 4.40 95% CI 3.14-6.03). Interestingly, the mortality estimated from the GRACE risk score was below the actual mortality assessed after the 3month follow-up. After adjustment for the GRACE risk score or for heart failure, dyspnea remained highly predictive of death and myocardial infarction within 3months (OR death adjusted for heart failure: 2.99 95% CI 1.99-4.47 and OR death adjusted for GRACE risk score: 3.37 95% CI 2.27-4.99).
  
  
  CONCLUSIONS
  Dyspnea is a common symptom in CPU patients. Our data show that dyspnea is associated with a fourfold higher 3month mortality which is underestimated by the established ACS risk scores. To improve their predictive value we therefore propose to add dyspnea as an item to common risk scores.
authors.affiliation: Clinic for Cardiology & Pneumology. Heart Centre Georg-August-University Göttingen, Germany.
authors.forename: Kristian
authors.initials: K
authors.lastname: Hellenkamp
authors.affiliation: Dept. of Cardiology, Angiology & Intensive Care Medicine, Vivantes Hospital Neukölln, Berlin, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Darius
authors.affiliation: Dept. of Cardiology, Angiology & Pneumology, Ruprecht-Karls-University Heidelberg, Germany.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giannitsis
authors.affiliation: Dept. of Cardiology, West-German Heart Centre University Essen, Germany.
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.affiliation: Dept. of Cardiology & Nephrology, Lukas Hospital Neuss, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Haude
authors.affiliation: Dept. of Cardiology, Kerckhoff Klinik Bad Nauheim, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Hamm
authors.affiliation: Clinic for Cardiology & Pneumology. Heart Centre Georg-August-University Göttingen, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Hasenfuss
authors.affiliation: Institute for Pathophysiology, University of Duisburg-Essen, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Heusch
authors.affiliation: Dept. of Cardiology, Pneumology and Internal Intensive Care Medicine, Klinikum Neuperlach, Städtisches Klinikum München GmbH, München, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Mudra
authors.affiliation: Dept. of Cardiology, Angiology & Intensive Care Medicine, Johannes Gutenberg University Mainz, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
authors.affiliation: Clinic for Cardiology and Angiology, Städtisches Klinikum Karlsruhe, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Schmitt
authors.affiliation: 2nd Dept. of Medicine, Westpfalzklinikum Kaiserslautern, Germany.
authors.forename: Burghard
authors.initials: B
authors.lastname: Schumacher
authors.affiliation: Foundation Institut für Herzinfarktforschung Ludwigshafen, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.affiliation: Centre for Cardiology and Angiology Frankfurt, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Voigtländer
authors.affiliation: Department of Internal Medicine II, University Hospital Regensburg, Germany. Electronic address: lars.maier@ukr.de.
authors.forename: Lars S
authors.initials: LS
authors.lastname: Maier
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D000367:Age Factors; D000368:Aged; D002637:Chest Pain / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D015897:Comorbidity; D017023:Coronary Angiography / Q000379:methods; D004417:Dyspnea / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D005260:Female; D005858:Germany / Q000453:epidemiology; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D008297:Male; D009026:Mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
keywords: Acute coronary syndrome; Chest pain; Dyspnea; Heart failure; Outcome; Prognosis