Effect of Patient’s Symptom Interpretation on In-Hospital Mortality in Acute Coronary Syndrome

• Published in: Circulation Journal Vol. 88; no. 8; pp. 1225 - 1234
• Main Authors: Nakamura, Akihiro, Nozaki, Tetsuji, Ozawa, Mahito, Nasu, Takahito, Maegawa, Yuko, Ninomiya, Ryo, Osaki, Takuya, Koeda, Yorihiko, Yoshizawa, Reisuke, Itoh, Tomonori, Ishida, Masaru, Saito, Hidenori, Onodera, Hiroyuki, Nishiyama, Osamu, Morino, Yoshihiro, Ishikawa, Yu
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 25.07.2024
• Subjects: Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - mortality; Acute Coronary Syndrome - therapy; Aged; Aged, 80 and over; Clinical prognosis; Female; Hospital Mortality; Humans; Male; Middle Aged; Onset-to-balloon time; Percutaneous Coronary Intervention - mortality; Prehospital awareness; Prognosis; Retrospective Studies; Risk Factors; Time Factors; Time-to-Treatment - statistics & numerical data; Clinical prognosis; Prehospital awareness; Risk factors; Onset-to-balloon time
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-24-0113

Background: The association between symptom interpretation and prognosis has not been investigated well among patients with acute coronary syndrome (ACS). As such, the present study evaluated the effect of heart disease awareness among patients with ACS on in-hospital mortality.Methods and Results: We performed a post hoc analysis of 1,979 consecutive patients with ASC with confirmed symptom interpretation on admission between 2014 and 2018, focusing on patient characteristics, recanalization time, and clinical outcomes. Upon admission, 1,264 patients interpreted their condition as cardiac disease, whereas 715 did not interpret their condition as cardiac disease. Although no significant difference was observed in door-to-balloon time between the 2 groups, onset-to-balloon time was significantly shorter among those who interpreted their condition as cardiac disease (254 vs. 345 min; P<0.001). Moreover, the hazard ratio (HR) for in-hospital mortality was significantly higher among those who did not interpret their condition as cardiac disease based on the Cox regression model adjusted for established risk factors (HR 1.73; 95% confidence interval 1.08–2.76; P=0.022).Conclusions: This study demonstrated that prehospital symptom interpretation was significantly associated with in-hospital clinical outcomes among patients with ACS. Moreover, the observed differences in clinical prognosis were not related to door-to-balloon time, but may be related to onset-to-balloon time.