Cor Vasa 2015, 57(1):e1-e5 | DOI: 10.1016/j.crvasa.2014.11.002

Outcomes of patients hospitalized for suspected acute coronary syndrome, in whom the diagnosis was not confirmed: Results from the CZECH-1 and CZECH-2 registries

Lenka Roblová^a, František Toušek^a,*, Petr Toušek^b, Ladislav Pešl^a, David Horák^c, Richard Rokyta^d, Pavel Červinka^e, Michael Želízko^f, Petr Janský^g, Michael Aschermann^h, František Holm^c, Vratislav Pechman^d, Jiří Jarkovskýⁱ, Petr Widimský^b

^a Kardiologické oddělení, Kardiocentrum, Nemocnice České Budějovice, České Budějovice, Česká republika

^b III. interní-kardiologická klinika, Kardiocentrum 3. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Královské Vinohrady, Praha, Česká republika

^c Kardiologické oddělení, Krajská nemocnice Liberec, Kardiocentrum, Liberec, Česká republika

^d Kardiologické oddělení, Fakultní nemocnice Plzeň, Plzeň, Česká republika

^e Kardiologická klinika, Masarykova nemocnice, Ústí nad Labem, Česká republika

^f Klinika kardiologie, Institut klinické a experimentální medicíny, Praha, Česká republika

^g Kardiologická klinika, 2. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice v Motole, Praha, Česká republika

^h II. interní klinika kardiologie a angiologie, 1. lékařská fakulta Univerzity Karlovy a Všeobecná fakultní nemocnice, Praha, Česká republika

ⁱ Institut biostatistiky a analýz Lékařské a Přírodovědecké fakulty Masarykovy univerzity, Brno, Česká republika

Background: Suspicion of acute coronary syndrome (ACS) is one of the most common reasons for hospital admission. However, ACS is not confirmed in a high proportion of these patients during hospitalization. Very few details exist about these patients.

Aim: To evaluate the clinical characteristics and outcomes of hospitalized patients with a suspicion for ACS that has not been confirmed and compare these results with patients with confirmed ACS.

Methods and results: Data were used from the CZECH-1 and CZECH-2 registries, collected in November 2005 and October-November 2012. Both registries contain data from all consecutive patients who have been hospitalized with an initial diagnosis of ACS. ACS was not confirmed during hospitalization in 578 of 1 921 patients (30.1%) in the CZECH-1 registry and in 372 of 1 221 (30.5%) in the CZECH-2 registry. In both registries, higher proportions of females (52 vs. 36%; p < 0.001 and 46 vs. 33%; p < 0.01, respectively) were observed between patients with unconfirmed ACS compared to those with confirmed ACS. A history of myocardial infarction was known in 25% of the patients with unconfirmed ACS in both registries. On admission, atrial fibrillation or other non-sinus rhythm on ECG was present in 17% of patients with unconfirmed ACS, bundle branch block in 18%, ST depression in 8%, and ST elevation in 3.6%. Coronary angiography was performed on 36% of these patients in CZECH-1 and 27% of patients in CZECH-2 (p < 0.01). In-hospital mortality of the ACS unconfirmed patients was 1.2% in the CZECH-1 registry and 2.1% in the CZECH-2 registry (p = NS). 30-day and 1-year mortality in patients with unconfirmed ACS in the CZECH-2 registry were significantly lower compared to patients with confirmed ACS (3.5 vs. 6.6%; p < 0.05 and 6.5 vs. 13%; p < 0.05, respectively). Musculoskeletal pain and acute heart failure were the most common discharge diagnosis in patients with unconfirmed ACS.

Conclusion: Hospitalized patients in whom the suspicion of ACS had not been confirmed were more often female and a high proportion had abnormal ECG on admission. In-hospital mortality was very low, and the 1-year mortality was significantly lower compared to patients with confirmed ACS.

Keywords: Acute coronary syndrome; Heart failure; Musculoskeletal pain; Outcome; Suspicion

Revised: November 9, 2014; Accepted: October 5, 2014; Published: February 1, 2015  Show citation