Abstract 10155: The Atypical Presentation and Clinical Outcomes of Non-ST-Segment Elevation Acute Coronary Syndromes in Chronic Kidney Disease Patients

Abstract

Introduction: The atypical presentation of acute coronary syndromes (ACS) was a risk factor of unfavorable outcomes. It is not uncommon for chronic kidney disease (CKD) patients with ACS to present atypically. Hypothesis: We hypothesized that the atypical presentation of non-ST-segment elevation ACS (NSTE-ACS) in CKD patients might associate with poor clinical outcomes. Methods: This was a retrospective cohort study in Srinagarind hospital, Thailand, from 2014 to 2017. The CKD patients with NSTE-ACS were enrolled. Clinical data including presenting symptoms, laboratory results, treatments, and outcomes were collected from an electronic database. The atypical presentation was defined as nausea and/or vomiting, dyspepsia, confusion, dyspnea, or no chest pain. The outcome was a composite of all-cause mortality, the over 30-day length of stay, and recurrent ACS underwent PCI or CABG. Results: There were 147 patients enrolled, of those, 77 (52.3%) presented with atypical symptoms. The atypical presentation group had a faster heart rate (HR) compared with those who presented with typical symptoms (87 vs. 78 beats per minute, P=0.005), however, both groups had comparable age, sex, and echocardiographic parameters. The determinant of the atypical presentation was HR (Odds ratio (OR) 1.03, 95%CI: 1.01-1.05). Atypical symptoms and diabetes mellitus were associated with the outcome, adjusted OR 2.62, 95%CI: 1.21-5.67, and adjusted OR 3.54, 95%CI: 1.56-8.03, respectively. Conclusions: ACS should be one of the differential diagnoses in the CKD patients who presented with nausea and/or vomiting, dyspepsia, confusion, dyspnea, or no chest pain. Considered that the atypical presentation was associated with poorer outcomes.