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• W1987668295 abstract "Aggressive treatment of chest pain is considered pivotal in acute coronary syndrome (ACS); the putative physiology being myocardial demand reduction by minimizing sympathetic amines. However, analyses of the impact of angina severity on clinical outcomes have never been published. We conducted a chart-based retrospective case control pilot study investigating the association between chest pain and adverse outcomes in adults under 80 years old with ACS. Patients with angina admitted for ACS who underwent cardiac catheterization without prior intervention or bypass were included. Composite outcome of re-infarction, heart failure/cardiomyopathy, ventricular arrhythmia, or mortality comprised Cases. Controls had none of these outcomes. ROC analysis defined good versus bad pain control, while one-way-ANOVA and Mann-Whitney-U testing determined magnitude and significance of pain reduction. Between-group differences in pain control were analyzed via Fisher's Exact testing. Angiographic findings were also compared between groups using these methods. Thirty eligible subjects were identified: 20 Cases, 10 Controls. Elimination of chest pain occurred in 93% (95% Controls, 90% Cases). Good versus bad pain control dichotomized subjects optimally based on whether chest pain was eliminated (0/10) within 12 hours [AUC 0.75; 95% CI 0.54-0.96; p=0.03]. Mean pain intensities remained higher for Cases, reaching significance at hour 12 [0.0/10 vs. 3.2/10; F=13.0, p=0.001; Mann-Whitney U=50, Wilcoxon W=260, 2-tailed p=0.001, 1-tailed p=0.028]. Five Cases and zero Controls experienced bad pain control [50%, 0%; Fisher p=0.002]. Presence of obstructive coronary lesions was higher among Cases but without statistical significance [66% vs. 69%, p=0.41]. In conclusion, adverse outcomes were associated with poorer antecedent pain control during initial treatment, which were not attributed to a discrepancy in intraluminal disease severity, implicating analgesia in ACS as an independent outcome predictor. To our knowledge, this is the first study to date examining the clinical consequence of inadequate analgesic treatment of angina in ACS. This study is limited by its small sample size. Aggressive treatment of chest pain is considered pivotal in acute coronary syndrome (ACS); the putative physiology being myocardial demand reduction by minimizing sympathetic amines. However, analyses of the impact of angina severity on clinical outcomes have never been published. We conducted a chart-based retrospective case control pilot study investigating the association between chest pain and adverse outcomes in adults under 80 years old with ACS. Patients with angina admitted for ACS who underwent cardiac catheterization without prior intervention or bypass were included. Composite outcome of re-infarction, heart failure/cardiomyopathy, ventricular arrhythmia, or mortality comprised Cases. Controls had none of these outcomes. ROC analysis defined good versus bad pain control, while one-way-ANOVA and Mann-Whitney-U testing determined magnitude and significance of pain reduction. Between-group differences in pain control were analyzed via Fisher's Exact testing. Angiographic findings were also compared between groups using these methods. Thirty eligible subjects were identified: 20 Cases, 10 Controls. Elimination of chest pain occurred in 93% (95% Controls, 90% Cases). Good versus bad pain control dichotomized subjects optimally based on whether chest pain was eliminated (0/10) within 12 hours [AUC 0.75; 95% CI 0.54-0.96; p=0.03]. Mean pain intensities remained higher for Cases, reaching significance at hour 12 [0.0/10 vs. 3.2/10; F=13.0, p=0.001; Mann-Whitney U=50, Wilcoxon W=260, 2-tailed p=0.001, 1-tailed p=0.028]. Five Cases and zero Controls experienced bad pain control [50%, 0%; Fisher p=0.002]. Presence of obstructive coronary lesions was higher among Cases but without statistical significance [66% vs. 69%, p=0.41]. In conclusion, adverse outcomes were associated with poorer antecedent pain control during initial treatment, which were not attributed to a discrepancy in intraluminal disease severity, implicating analgesia in ACS as an independent outcome predictor. To our knowledge, this is the first study to date examining the clinical consequence of inadequate analgesic treatment of angina in ACS. This study is limited by its small sample size." @default.
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• W1987668295 date "2014-04-01" @default.
• W1987668295 modified "2023-09-23" @default.
• W1987668295 title "(479) Determining the association between adverse clinical outcomes and inadequate chest pain control in acute coronary syndrome: a case-control pilot study" @default.
• W1987668295 doi "https://doi.org/10.1016/j.jpain.2014.01.390" @default.
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