title: Degree of dyspnoea in patients with non-ST-elevation acute coronary syndrome: A report from Japanese multicenter registry.
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.
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Shiraishi
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Shun
authors.initials: S
authors.lastname: Kohsaka
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Ikuko
authors.initials: I
authors.lastname: Ueda
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Inohara
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Sawano
authors.affiliation: Department of Cardiology, Ashikaga Red Cross Hospital, Ashikaga, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Numasawa
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashida
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Maekawa
authors.affiliation: Department of Cardiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Momiyama
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000401:mortality; D058186:Acute Kidney Injury; D000368:Aged; D004417:Dyspnea / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007564:Japan; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology
keywords: acute heart failure; dyspnoea; non-ST-elevation acute coronary syndrome; risk stratification