In a new study from Braga Hospital, researchers found just 76% of heart attack patients with dyspnoea (shortness of breath) or fatigue as their main symptom are alive at one year compared to 94% of those with chest pain as the predominant feature.
The study was presented at ESC Acute CardioVascular Care 2022 and was conducted by Dr. Paulo Medeiros et al.
Chest pain is the hallmark presentation of myocardial infarction but other complaints such as shortness of breath, upper abdominal or neck pain, or transient loss of consciousness (blackouts) may be the reason to attend the emergency department.
In the study, the team examined which patients tend to present with atypical complaints and whether these symptoms result in the same consequences as chest pain.
The study focused on non-ST-elevation myocardial infarction (NSTEMI), a type of heart attack in which an artery supplying blood to the heart becomes partially blocked.
The team used data from 4,726 patients aged 18 years and older. The average age of study participants was 68 years and 71% were men.
Patients were divided into three groups according to their main symptoms at presentation.
Chest pain was the most common presenting symptom (4,313 patients; 91%), followed by dyspnoea/fatigue (332 patients; 7%) and syncope (81 patients; 2%).
Patients with dyspnoea/fatigue were much older than those in the other two groups, with an average age of 75 years compared with 68 years in the chest pain group and 74 years in the syncope group.
Those with dyspnoea/fatigue were also more commonly women (42%) compared to patients with chest pain as the main symptom (29% women) or syncope (fainting, 37% women).
Compared to the other two groups, patients with dyspnoea/fatigue as their main symptom were more likely to have high blood pressure, diabetes, chronic kidney disease and chronic obstructive pulmonary disease (COPD).
The researchers compared rates of survival between the three groups at one year.
At one year after the heart attack, 76% of patients in the dyspnoea/fatigue group were alive compared with 94% of the chest pain group and 92% of the syncope group.
During the year after their heart attack, 76% of patients in the dyspnoea/fatigue group avoided being hospitalized for a cardiovascular reason compared with 85% of the chest pain group and 83% of the syncope group.
The team says patients presenting with shortness of breath or fatigue had a worse prognosis than those with chest pain.
They were less likely to be alive one year after their heart attack and also less likely to stay out of hospital for heart problems during that 12-month period.
Related: This common antibiotic drug linked to higher heart attack risk
A previous study from the German Institute for Quality and Efficiency in Health Care found that treatment with a statin in combination with ezetimibe could benefit patients with a history of heart attacks and stroke.
The benefit from the drug combo is stonier than that from treatment with a statin alone.
In addition, the combination of a statin plus the lipid-lowering drug alirocumab may also provide better health benefits than a statin alone.
Cardiovascular diseases are diseases that originate from the vascular system and/or the heart.
They were the most common cause of death worldwide in 2016, accounting for 31% of all deaths. Of these causes of death, 85% resulted from a heart attack or stroke.
One of the largest modifiable risk factors is a high LDL cholesterol level (LDL = low-density lipoprotein, or ‘bad’ cholesterol).
The reduction in LDL cholesterol is, therefore, an important goal in the prevention of cardiovascular diseases.
In patients with a history of heart disease, using cholesterol-lowering drugs is recommended. Statins are currently the most commonly prescribed group of drugs in this regard.
Recent research has shown that a combination of statin and ezetimibe has also been used to further reduce LDL cholesterol.
In that study, the researchers examined the benefit of treatment with ezetimibe in combination with a statin to reduce the risk of heart attacks and strokes in patients with a history of heart problems.
They compared this treatment with the treatment with a combination of statin and another drug influencing lipid metabolism.
The team found in patients with a history of heart disease, there was a greater benefit of ezetimibe in combination with a statin versus a statin alone. For these patients, the additional use of ezetimibe reduces the risk of suffering a heart attack or a stroke.
The team also found that the combination therapy of a statin plus ezetimibe was not superior to the combination of a statin plus alirocumab.
If you care about heart disease, please read studies about a big cause of heart failure, and a new way to repair human heart.
For more information about heart health, please see recent studies about common painkillers that may harm your heart, kidneys, sleep and bodyweight, and results showing drinking energy drink too much may lead to heart failure.
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