Prognosis and risk indicators of death during a period of 10 years for women admitted to the emergency department with a suspected acute coronary syndrome

Abstract

Aim: To describe the 10-year prognosis and risk indicators of death in women admitted to the emergency department with acute chest pain or other symptoms raising a suspicion of acute myocardial infarction (AMI). Particular interest was paid to women of ≤75 years of age surviving 1 month after admission, who were judged to have suffered a possible or confirmed acute ischemic event with signs of either minor or no myocardial damage. Patients: All women admitted to the emergency department at Sahlgrenska University Hospital, Göteborg, during a period of 21 months, due to acute chest pain or other symptoms raising a suspicion of AMI. Methods: All the women were followed prospectively for 10 years. The subset described previously underwent a bicycle exercise tolerance test and metabolic screening 3 and 4 weeks, respectively, after admission to the emergency department. Results: In all, 5362 patients were admitted to the emergency department on 7157 occasions during the time of the survey and 2387 (45%) of them were women. Of these women, 61% were hospitalised and 39% were sent home directly. The overall 10-year mortality for women was 42.5% (55.5% among those hospitalised and 21.8% among those not hospitalised). Of the variables recorded at the emergency department, the following were independently associated with 10-year mortality: age, history of angina pectoris, history of hypertension, history of diabetes, history of congestive heart failure, pathological ECG on admission, degree of initial suspicion of AMI on admission, symptoms of congestive heart failure on admission and other non-specific symptoms on admission. The majority of these risk factors were more markedly associated with prognosis in women discharged directly from the emergency department than in those hospitalised. In the subset aged ≤75 years defined above (n=241), the following were independent predictors of death: a history of AMI and working capacity in a bicycle exercise tolerance test. Conclusion: Among women admitted to hospital due to chest pain or other symptoms raising a suspicion of AMI, 42.5% had died after 10 years. Major risk indicators of death were age, history of cardiovascular disease, pathological ECG on admission and symptoms of congestive heart failure on admission. Women presenting with an acute coronary syndrome but minimal myocardial damage, work capacity and a history of AMI predicted a poor outcome.

Introduction

Of the patients who come to an emergency department with acute chest pain, a large percentage are women [1]. Women who suffer from chest pain have been reported to differ from men, having coronary artery disease less frequently [2], [3]. The long-term outcome for women with an episode of acute chest pain or other symptoms raising a suspicion of an acute ischemic event is less well described in the literature.

This study aims to describe the 10-year prognosis for all women admitted to a single hospital due to acute chest pain or other symptoms raising a suspicion of acute myocardial infarction (AMI). Our hypothesis was that risk indicators of death could already be defined at the emergency department and that the influence of these risk indicators on prognosis could differ among women who were hospitalised and women who were discharged directly from the emergency department. We were also aiming to describe the long-term prognosis in relation to the final diagnosis.

Finally, we studied women ≤75 years of age who survived for 4 weeks and were judged to have suffered a suspected or confirmed ischemic event with signs of minor or no myocardial damage. In this subset, we attempted to define the risk indicators of 10-year mortality based on metabolic factors, psychosocial factors, observations at an exercise tolerance test, final diagnosis, previous history and acute symptoms.