Abstract: AIMS: The presence of accompanying dyspnoea is routinely assessed and common in patients presenting with acute chest pain/discomfort to the emergency department (ED). We aimed to assess the association of accompanying dyspnoea with differential diagnoses, diagnostic work-up, and outcome. METHODS AND RESULTS: We enrolled patients presenting to the ED with chest pain/discomfort. Final diagnoses were adjudicated by independent cardiologists using all information including cardiac imaging. The primary diagnostic endpoint was the final diagnosis. The secondary diagnostic endpoint was the performance of high-sensitivity cardiac troponin (hs-cTn) and the European Society of Cardiology (ESC) 0/1h-algorithms for the diagnosis of myocardial infarction (MI). The prognostic endpoints were cardiovascular and all-cause mortality at two years. Among 6045 patients, 2892/6045 (48%) had accompanying dyspnoea. The prevalence of acute coronary syndrome (ACS) in patients with vs. without dyspnoea was comparable (MI 22.4% vs. 21.9%, P = 0.60, unstable angina 8.7% vs. 7.9%, P = 0.29). In contrast, patients with dyspnoea more often had cardiac, non-coronary disease (15.3% vs. 10.2%, P < 0.001). Diagnostic accuracy of hs-cTnT/I concentrations was not affected by the presence of dyspnoea (area under the curve 0.89-0.91 in both groups), and the safety of the ESC 0/1h-algorithms was maintained with negative predictive values >99.4%. Accompanying dyspnoea was an independent predictor for cardiovascular and all-cause death at two years [hazard ratio 1.813 (95% confidence intervals, 1.453-2.261, P < 0.01)]. CONCLUSION: Accompanying dyspnoea was not associated with a higher prevalence of ACS but with cardiac, non-coronary disease. While the safety of the diagnostic work-up was not affected, accompanying dyspnoea was an independent predictor for cardiovascular and all-cause death. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT00470587, number NCT00470587.
Tags: (P400PM_180828), the Swiss Heart Foundation, and the Women and Heart Foundation,, (P400PM_191037/1), the Swiss Heart Foundation (FF20079), the Prof. Dr. Max, *Acute Coronary Syndrome, *Myocardial Infarction/diagnosis, 0/1h-algorithm, accessible websites or e-print servers. We disclose that J.B. received research, accuracy of the data analysis. All authors have read and approved the manuscript., Acon, Amgen, Astra Zeneca, Boehringer Ingelheim, Bayer, BMS, Idorsia, Novartis,, and speaker honoraria from Abbott, Roche, Siemens, and Ortho Clinical, Biomarkers, Biomerieux, Idorsia, Novartis, Ortho Cinical Diagnostics, Quidel, Roche, Siemens,, Chest Pain/diagnosis/etiology, Clinical Diagnostics, and Orion Pharma, all outside the submitted work. L.K., Cloetta Foundation, the Margarete und Walter Lichtenstein-Stiftung (3MS1038), the, contents have not been published previously and are not being considered for, data, vouched for the data and analysis, wrote the paper, and decided to publish., decision to submit the manuscript for publication., declare that they have no conflict of interest with this study. The hs-cTn assays, Diagnosis of MI, Diagnostics, Ortho Clinical Diagnostics, and Quidel Corporation. T.N. has, Diagnostics. C.M. has received research support from the Swiss National Science, Division of Internal Medicine, the Swiss Academy of Medical Sciences, the, Dyspnea/diagnosis/epidemiology/etiology, Dyspnoea, Foundation (P500PM_206636), and speaker honoraria from Siemens, Roche, Foundation, the Swiss Heart Foundation, the KTI, the European Union, the, gathering or analysing the data or writing the manuscript. The manuscript and its, Gottfried and Julia Bangerter-Rhyner Foundation, and the Swiss National Science, grants from the University of Basel, the University Hospital of Basel, the, High-sensitivity cardiac troponin, honoraria from Quidel, outside the submitted work, paid to the institution. K.W., honoraria/consulting honoraria from Siemens, Beckman Coulter, Bayer, Ortho, Hospital Foundation, and a PhD scholarship of the University of Queensland. T.Z., Humans, in the study and take responsibility for the integrity of the data and the, investigated were donated by the manufacturers, who had no role in the design of, J.B., T.N., L.K., P.L.-A., M.R.G., K.W., and C.M. had full access to all the data, M.R.G. received research grants from the Swiss National Science Foundation, Medical Sciences, and the Gottfried and Julia Bangerter-Rhyner Foundation, as, Osler, Roche, and Sanofi, outside of the submitted work. All other authors, Predictive Value of Tests, Prognosis, publications elsewhere in whole or in part in any language, including publicly, received a research grant from the 'Freiwillige Akademische Gesellschaft Basel',, received a research grant from the University of Basel, the Swiss Academy of, received research support from the 'Freiwillige Akademische Gesellschaft Basel'., received research support from the Swiss National Science Foundation, research grants from the Swiss Heart Foundation (FF20079 and FF21103) and speaker, Singulex, and Sphingotec, as well as speaker honoraria/consulting honoraria from, the Gottfried and Julia Bangerter-Rhyner Foundation, and the Prince Charles, The sponsors had no role in designing or conducting the study and no role in, the study, the analysis of the data, the preparation of the manuscript, or the, Troponin T, University Basel, and the University Hospital Basel as well as speaker, University of Basel, the University Hospital Basel, Abbott, Beckman Coulter,, well as the 'Freiwillige Akademische Gesellschaft Basel'. P.L.-A. has received.
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