Abstract
Background
Heart disease is one of the leading causes of death globally V体育平台登录. Clinical symptoms are among the first predictors of heart disease. This study was conducted to investigate the predictive role of symptoms in left main coronary artery (LM) and three-vessel disease (3VD) in patients with myocardial infarction.
Methods
In this analytical and Cross-sectional study, 177 cardiac patients with myocardial infarction who referred to the emergency department of Imam Reza and Ghaem hospitals in Mashhad were included in the study using a purposive method and in accordance with the inclusion criteria. At the beginning of the study and after obtaining informed consent, 12-lead ECGs were obtained from the patients and a demographic questionnaire and clinical symptom checklist were completed for all patients VSports注册入口. Blood pressure, pulse, and respiration rate were measured by the researcher, while the presence of nausea, pain, shortness of breath, and other subjective symptoms were self-reported by the patient. The Visual Analog Scale (VAS) was used to determine pain intensity. Then, the patients underwent angiography by a cardiologist, and the angiographies were performed by one person. Data analysis was performed using SPSS version 21 software. The normality of quantitative variables was assessed using the Kolmogorov-Smirnov test. The chi-square test was used to compare the frequency of clinical symptoms in the three groups. Logistic regression was used to determine the association of clinical symptoms with pain and QRS duration with 3VD and LM.
Results
Among the participants, 19 (10. 7%) had both LM and 3VD, 69 (39%) had either LM or 3VD, and 89 (50. 3%) had neither. A significant difference in pain intensity was also found between the three groups. Patients with either LM or 3VD experienced more intense pain, whereas those with both LM and 3VD reported less severe pain compared to the other two groups. Logistic regression analysis showed that the odds of having 3VD or LM were 5. 2 times higher in patients with shortness of breath in addition to pain, compared to those without shortness of breath (CI = 1. 60-16. 94) V体育官网入口.
VSports注册入口 - Conclusions
In the present study, Patients who experienced shortness of breath in addition to pain were more likely to have LM and 3VD. Given that both conditions are associated with higher mortality rates and poorer prognoses, Paying attention to these signs is important VSports在线直播.
Keywords: Clinical symptoms, QRS, Dyspnea, Pain, Left main, Three-vessel coronary artery involvement, Myocardial infarction
Introduction
According to data from the National Health and Nutrition Examination Survey (NHANES), the overall prevalence of cardiovascular disease (CVD), including coronary heart disease (CHD), heart failure (HF), stroke, and hypertension among adults aged over 20 years, is 49. 2% (126. 9 million in 2018), and it increases with age in both men and women [1]. Heart disease is one of the leading causes of death globally [2–7], accounting for 31% of all health-related deaths worldwide [4, 5, 8]. Although mortality primarily due to ischemic heart disease and stroke has declined in Europe, North America, and Australia since the late 20th century, cardiovascular disease (CVD) remains the leading cause of death and disability worldwide [4]. One-third of these deaths occur prematurely, in individuals under the age of 70 [9]. In 2019, cardiovascular disease was the leading cause of death, responsible for 9. 6 million deaths among men and 8. 9 million among women, accounting for nearly one-third of all global deaths [10]. By 2020, approximately 19 million deaths worldwide were attributed to CVD, reflecting an 18. 7% increase since 2010 [11]. Approximately three-quarters of these deaths occur in low- and middle-income countries [8, 12]. By 2030, cardiovascular diseases are projected to cause over 23 million deaths globally, accounting for around 30 VSports. 5% of all deaths [13].
The Islamic Republic of Iran has one of the highest age-standardized rates of cardiovascular disease prevalence and mortality [8, 9]. According to the Global Burden of Disease Study, in both 2010 and 2015, CVD was responsible for 46% of all deaths and approximately 20–23% of the total disease burden in Iran [14] VSports app下载. According to the Iranian Ministry of Health and Medical Education, cardiac-related mortality has reached its highest level in Iran [15, 16]. By 2025, the cardiovascular disease burden in the country is projected to be more than twice the level recorded in 2005 [8, 9].
One of the main forms of coronary artery disease is a heart attack. Acute myocardial infarction (MI) is one of the most severe coronary artery diseases [17, 18] and can lead to heart failure [19]. Acute myocardial infarction remains one of the leading causes of death worldwide, responsible for approximately three million deaths each year. In a study conducted in Fasa, Iran, the prevalence of STEMI and NSTEMI was reported as 31. 60% and 11. 80%, respectively [18]. In Korea, a study observed a significant 57. 0% increase in the total number of acute myocardial infarction (AMI) cases from 2011 to 2019, followed by a slight decrease in 2020 [7]. In the United States, approximately 605,000 first-time (incident) myocardial infarctions and 200,000 recurrent myocardial infarctions occur annually [3]. The prevalence of LM/3VD (left main/3-vessel disease) has been reported to range from 18. 2 to 30 V体育官网. 2% in different studies [20–22]. People with cardiovascular disease or those at risk of developing it require timely diagnosis and treatment [8]. However, predicting the condition is challenging for doctors worldwide, as it demands a high level of expertise and knowledge [3]. The diagnosis and treatment of heart disease are particularly complex in developing countries due to the limited availability of effective diagnostic tools, along with shortages of medical professionals and other resources that affect prognosis and appropriate treatment. Patients often face inadequate preventive measures and a lack of skilled or experienced medical professionals in this field [23]. Among patients with myocardial infarction, those with LM/3VD have a poorer prognosis and are more likely to be candidates for coronary artery bypass grafting (CABG) [21, 24]. The presence of 3VD in patients with acute coronary syndrome is considered the most severe and fatal form of cardiovascular disease, as it involves occlusion of three major coronary arteries: the left anterior descending artery (LAD), the right coronary artery (RCA), and the left circumflex artery [20]. Left main coronary artery involvement is an independent predictor of both morbidity and mortality among patients with coronary artery disease (CAD) and can result in severe cardiovascular morbidity and mortality in the general population [25].
Early diagnosis of patients with LM/3VD is crucial for determining and implementing the most effective revascularization strategy, appropriate use of antiplatelet drugs, and prognostic risk stratification [21, 22, 26]. The efficacy of treatment largely depends on the timely initiation of necessary therapies to minimize myocardial damage [27]. Therefore, identifying patients through early and noninvasive predictors would be clinically valuable [21]. Several studies have investigated predictive factors for LM/3VD, including electrocardiographic indices [21, 22, 26], and some have even developed machine learning models to predict heart disease [3, 23, 28].
Clinical symptoms are the first criteria for judging heart disease. Chest, arm, and jaw pain are typically considered indicative of cardiac pain. The prevalence of chest pain is 91% in men and 92% in women [29]. Additionally, patients may also experience nausea, vomiting, and shortness of breath [30]. In the Botker study, the prevalence of chest pain in myocardial infarction was 70% and shortness of breath was 8%. In patients with shortness of breath, 30-day and 4-year mortality was higher compared to patients with chest pain [31].
The present study explores the predictive role of clinical and initial symptoms, which are readily available and can be crucial in the first encounter with the patient. Rapid diagnosis and appropriate, timely intervention can be life-saving. This study aimed to compare the clinical symptoms at the time of admission in patients with LM involvement and 3VD with other patients suffering from myocardial infarction.
Materials and methods
In this analytical Cross-sectional study, we compared the clinical symptoms of patients upon admission with left main coronary artery involvement and three-vessel coronary artery disease with other patients experiencing myocardial infarction.
Study population
The study sample comprised 177 patients with heart attacks admitted to the emergency departments of Imam Reza and Qaem Hospitals in Mashhad during 2024. Using G Power version 3.1.9.2, f-tests family, and Linear multiple regression: Fixed model, R² increase, with a 95% confidence level, 80% power, a partial R² of 0.084, and 6 predictor variables, a sample size of 158 participants was determined. A pilot study suggested a partial R² of 0.084. Considering a 10% dropout rate, the final sample size was calculated to be 174. Inclusion criteria included: willingness to participate in the study, a myocardial infarction (STEMI and NSTEMI) diagnosis by a specialist, no history of CABG, no history of kidney disease, no right or left bundle branch block on admission ECG, and consent for initial angiography. The criteria for diagnosing right and left bundle branch block in addition to the QRS complex duration was greater than or equal to 0.12 seconds, in right bundle branch block pattern were: rsR’ or M-shaped pattern in leads V1 or V2, and a wide S wave in lateral leads. Similarly, in left bundle branch block pattern were: M-shaped pattern in leads V5 or V6, and a wide R wave in lateral leads, and absence of the physiological Q wave in lateral leads. Exclusion criteria included: refusal to continue participation at any stage of the study, death or cardiac resuscitation of the patient, and withdrawal from angiography. The sampling method was purposive.
"V体育平台登录" Clinical data collection
The data collection tools consisted of a demographic information questionnaire including: age, gender, marital status, education, occupation, history of diseases (such as diabetes, hypertension, etc.), history of medication use, history of open-heart surgery, and history of tobacco use. A clinical symptom checklist including: blood pressure, respiration and pulse, presence of pain, nausea, and dyspnea was also used. The presence of nausea, pain, shortness of breath, and other subjective symptoms were self-reported by the patient (recorded as yes or no). Additionally, the Visual Analog Scale (VAS) was used to measure pain intensity. A calibrated Cardiofax S 1250 Nihon Kohden electrocardiogram (ECG) device, a Siemens angiography device for angiography, and an APK2 mercury sphygmomanometer were used for all patients.
The data collection method was as follows: After the approval of the study protocol and obtaining permission from Gonabad University of Medical Sciences and authorization from two hospitals, sampling was done using a purposive method from cardiac patients who referred to the emergency departments of the mentioned hospitals. Patients suffering from myocardial infarction who met the inclusion criteria and consented to participate signed an informed consent form and entered the study. Initially, a 12-lead ECG was taken from patients, and the demographic questionnaire and clinical symptom checklist were completed for all patients. A 12-lead ECG was used for the initial diagnosis and to rule out bundle branch blocks. Subsequently, patients underwent angiography performed by a cardiology specialist, with all angiographies performed by the same individual. The angiographer was unaware of the patient’s symptoms. After angiography, patients were divided into three groups based on the affected region: one group with involvement of the LM or 3VD, a second group with combined 3VD and LM involvement, and a third group with none of these conditions. This study was conducted to investigate the effect of the coexistence of these two conditions and compare it with patients who had one of these two conditions.
Statistical analyses
The data were entered into SPSS software version 21 according to the respective groups. Mean, standard deviation, and frequency were used to describe the research units. The normality of quantitative variables was assessed using the Kolmogorov-Smirnov test. To compare age across the three groups with a normal distribution, one-way analysis of variance (ANOVA) was applied. To compare BMI in three groups (no normal distribution), Kruskal Wallis was used. Chi-square test was used to compare the frequency of qualitative demographic variables(sex, marital status,…) and clinical symptoms among the three groups.
Logistic regression was then applied to determine the relationship between significant variables identified in the initial analysis, with 3VD and LM involvement. To perform logistic regression, the research units were divided into two groups. The group that had either LM or 3VD, or both, was placed in one group, while the group whose angiography did not involve any of these conditions was placed in the other group. Then, the relationship between clinical symptoms and the duration of the QRS complex was examined in both groups.
Results
Clinical characteristics of study population
Of the 177 participating patients, none dropped out of the study. Overall, the frequency of LM involvement was 13%. The 3VD was observed in 84 patients (47.5%) of the study population (Table 1). For statistical analysis, patients were divided into three groups: those with both LM and 3VD, those with either LM or 3VD, and those with neither. Among the participants, 19 (10.7%) had both LM and 3VD, 69 (39%) had either LM or 3VD, and 89 (50.3%) had neither (Table 2). No significant differences were found between the three groups in terms of age, BMI (Table 3), sex, occupation, underlying diseases, marital status, or education (Table 4) (P > 0.05). The duration of the QRS complex showed a significant difference across the three groups (Table 3) (p < 0.001).
Table 1.
The overall frequency (either combined or separately) of LM and 3VD in patients
| 3VD | LM | |||
|---|---|---|---|---|
| No. | Percent | No. | Percent | |
| Yes | 84 | 47.5 | 23 | 13 |
| No | 93 | 52.5 | 154 | 87 |
| Total | 177 | 100 | 177 | 100 |
Table 2.
Frequency of research units in three groups
| No. | Percent | |
|---|---|---|
| LM or 3VD | 69 | 39 |
| LM + 3VD | 19 | 10.7 |
| No LM/3VD | 89 | 50.3 |
| Total | 177 | 100 |
Table 3.
Comparison of qualitative demographic Variables among the Three Groups
| LM or 3VD N (Percent) |
LM + 3VD N (Percent) |
No LM/3VD N (Percent) |
Test | |
|---|---|---|---|---|
| Sex | χ²= 2.749 | |||
| Male | 50(72.46) | 12(63.15) | 71(79.77) | p = 0.253 |
| Female | 19(27.54) | 7(36.85) | 18(20.23) | |
| Occupation | χ²= 3.822 | |||
| Government job | 3(4.34) | 1(5.26) | 10(11.23) | p = 0.431 |
| No government | 45(65.21) | 10(52.63) | 53(59.55) | |
| Unemployed | 21(0.45) | 8(42.11) | 26(29.22) | |
| Underlying disease | χ²= 0.474 | |||
| No | 35(50.7) | 10(52.6) | 50(56.2) | p = 0.789 |
| Yes | 34(49.3) | 9(47.4) | 39(43.8) | |
| Marital status | χ²= 3.179 | |||
| Married | 59(85.5) | 19(100) | 76(85.39) | p = 0.204 |
| Single | 10(14.5) | 0(0) | 13(14.61) | |
| Education | χ²= 1.032 | |||
| Illiterate | 21(30.4) | 7(36.84) | 25(28.08) | p = 0.905 |
| Below diploma | 30(34.47) | 7(36.84) | 36(40.44) | |
| Diploma and above | 18(26.10) | 5(26.32) | 28(31.48) |
Table 4.
Comparison of age and BMI among the Three Groups
| LM or 3VD Mean ± std |
LM + 3VD Mean ± std |
No LM/3VD Mean ± std |
Test | |
|---|---|---|---|---|
| Age | 59.99 ± 8.79 | 62.16 ± 10.44 | 58.30 ± 13.19 |
One way ANOVA: F = 1.061, P = 0.348 |
| BMI | 26.33 ± 2.48 | 27.29 ± 7.11 | 26.07 ± 3.94 |
Kruskal Wallis: χ²= 3.321, p = 0.190 |
| QRS duration(ms) | 25.10 ± 109.54 | 23.16 ± 125.26 | 19.94 ± 96.03 |
Kruskal Wallis: χ²= 22.72, p < 0.001 |
Symptoms in three groups
The most common symptom reported by all patients was “pain alone,” with 92 patients (52%) complaining solely of pain. The second most common symptom was pain accompanied by shortness of breath, reported by 22 patients (12.3%). Only 7 patients (4%) were asymptomatic (Table 5).
Table 5.
Frequency of symptoms in patients
| Symptom | No.(percent) |
|---|---|
| No sign | 7(4) |
| Just Pain | 92(52) |
| Just Dyspnea | 18(10.2) |
| Just Nausea | 15(8.5) |
| Pain + Nausea | 18(10.2) |
| Pain + dyspnea | 22(12.3) |
| Pain + nausea + dyspnea | 5(2.8) |
| Total | 177(100) |
In the three groups, none of the patients with both LM and 3VD were asymptomatic. Among them, 47.4% complained of shortness of breath alone, and 10.5% had shortness of breath accompanied by pain. In this group, 31.6% reported pain as the only symptom. In the group with either LM or 3VD, 43.5% mainly complained of pain, followed by pain combined with shortness of breath, reported by 23.2%. In the group without LM or 3VD, 62.9% reported pain, which was more prevalent than in the other two groups. Nausea was the second most common symptom in this group, reported by 11.2% of patients. The chi-square test revealed a statistically significant difference in the frequency of dyspnea between the groups with and without LM involvement (P = 0.001) (Table 6). Also the chi-square test revealed a statistically significant difference in the frequency of dyspnea between the groups with and without 3VD (P < 0.001) (Table 7). A statistically significant difference in symptom distribution was observed among the three groups (P < 0.001) (Table 8).
Table 6.
Comparison of dyspnea in LM/ no LM groups
| Dyspnea | LM N(percent) |
No LM N(percent) |
|---|---|---|
| No | 10(43.5) | 122(79.2) |
| Yes | 13(56.5) | 32(20.8) |
| Total | 23(100) | 154(100) |
Chi square test: χ²= 13.484 P = 0.001
Table 7.
Comparison of dyspnea in 3VD/no 3VD groups
| Dyspnea | 3VD N(percent) |
No 3VD N(percent) |
|---|---|---|
| No | 52(61.9) | 80(86) |
| Yes | 32(38.1) | 13(14) |
| Total | 84(100) | 93(100) |
Chi square test: χ²= 13.539 P < 0.001
Table 8.
Comparison of symptoms and complaints in three groups
| LM or 3VD | LM + 3VD | No LM/3VD | Total | |
|---|---|---|---|---|
| N(percent) | N(percent) | N(percent) | No(percent) | |
| No sign | 4(5.9) | 0(0) | 3(3.4) | 7(4) |
| Just Nausea | 3(4.3) | 2(10.5) | 10(11.2) | 15(8.5) |
| Just Pain | 30(43.5) | 6(31.6) | 56(62.9) | 92(52) |
| Just Dyspnea | 5(7.2) | 9(47.4) | 4(4.5) | 18(10.2) |
| Pain + Nausea | 9(13) | 0(0) | 9(10.1) | 18(10.2) |
| Pain + dyspnea | 16(23.2) | 2(10.5) | 4(4.5) | 22(12.4) |
| Pain + Nausea + dyspnea | 2(2.9) | 0(0) | 3(3.4) | 5(2.7) |
| Total | 69(100) | 19(100) | 89(100) | 177(100) |
| Test | Likelihood ratio: 43.77 p < 0.001 | |||
A significant difference in pain intensity was also found between the three groups. Patients with either LM or 3VD experienced more intense pain, whereas those with both LM and 3VD reported less severe pain compared to the other two groups (P < 0.001) (Table 9).
Table 9.
Comparison of severity of pain in three groups
| Mean ± std | |
|---|---|
| LM or 3VD | 7.74 ± 1.85 |
| LM + 3VD | 5.84 ± 2.41 |
| No LM/3VD | 7.10 ± 1.92 |
Kruskal-wallis Test: chi-square: 21.36 p < 0.001
Logistic regression analysis showed that the odds of having 3VD or LM were 5.2 times higher in patients with shortness of breath combined with pain, compared to those without shortness of breath (P = 0.006) (Table 10).
Table 10.
Correlation of clinical symptoms with 3VD and/or LM using logistic regression
| B | S.E | Sig | EXP(B) | CI 95% | ||
|---|---|---|---|---|---|---|
| lower | upper | |||||
| Constant | −3.234 | 0.990 | 0.001 | 0.039 | ||
| Nausea | −2.018 | 1.097 | 0.066 | 0.133 | 0.015 | 1.140 |
| Dyspnea | 1.652 | 0.601 | 0.006 | 5.29 | 1.607 | 16.949 |
| QRS duration(ms) | 0.029 | 0.010 | 0.003 | 1.029 | 1.010 | 1.049 |
Discussion (V体育2025版)
The results of the present study showed that the rate of LM involvement in patients with myocardial infarction was 13%, which is higher than the rates reported in the Senior study [32] and the Baligar study [33]. In the Senior study [32], the LM involvement rate was reported as 8%, while in the Baligar study, it was 9%. This difference may be attributed to variations in the age and sex distribution of participants across the studies. In the Baligar study, 86% of participants were male with a mean age of 57 years [31], while in the Senior study, 74% were male with a mean age of 63 years [30]. In the present study, the rate of 3VD was 47.5%, compared to 24% in the Baligar study [33]. In a study by Ahmed et al., the overall frequency of 3VD was reported as 30.2% [20]. The higher rate in the present study may be due to the inclusion of both STEMI and NSTEMI patients, whereas Ahmed’s study included only NSTEMI cases. The most common symptom among all patients in the current study was “pain only,” reported by 52% of patients. Overall, pain in combination with other symptoms (such as dyspnea and nausea) was reported in 77.4% of patients. Similarly, in the study by Medeiros, pain was also identified as the most common symptom; however, its frequency was higher at 91.3% [34]. The second most common clinical symptom in the present study was dyspnea, with a frequency of 25.4%, whereas in the Medeiros study, dyspnea and syncope were observed in only 7% of patients [34]. These discrepancies are likely due to differences in the study populations: Medeiros’ study included only NSTEMI patients, whereas the present study involved both STEMI and NSTEMI cases. Moreover, 75.1% of participants in the present study were female, while 70.1% of those in the Medeiros study were male [34]. Despite these demographic differences, both studies identified pain as the predominant clinical manifestation, followed by dyspnea.
In the present study, a statistically significant difference in clinical symptoms was observed among the three groups. The results showed that, in patients with both LM coronary artery and 3VD involvement, the most frequent symptom was shortness of breath, followed by pain. In the group with either LM or 3VD, the most common symptom was pain, followed by a combination of pain and shortness of breath—both of which were more frequent than other symptoms.
A significant difference in pain intensity was also noted among the three groups. Patients with either LM or 3VD reported more intense pain, while those with both LM and 3VD experienced less severe pain compared to the other two groups. No previous study was found that specifically compared pain intensity across these three categories. In other words the results of the present study showed Pain intensity was lower in the group with both conditions (LM and 3VD) compared to the other two groups. This finding was unexpected, and the following reasons may explain it: The simultaneous involvement of LM and 3VD (left main and three-vessel disease) may lead to chronic ischemia. In this situation, the body may gradually adapt to the ischemia, and the sensitivity of pain receptors may decrease. This mechanism is similar to diabetic neuropathy, where chronic nerve damage leads to a reduction in pain sensation. Perhaps the type of ischemia resulting from the combined involvement of LM and 3VD differs from the ischemia resulting from the isolated involvement of other vessels. It is possible that the ischemia caused by the combined involvement is more often ‘silent ischemia,’ producing fewer symptoms. Extensive involvement of coronary vessels (such as LM and 3VD) may lead to significant changes in the autonomic nervous system. These changes could affect the way pain is processed, leading to a reduction in its intensity. Another possibility is that it relates to the difference in age. Although the average age did not differ significantly between the three groups, the LM + 3VD group had a higher average age. The psychological state of these individuals may have differed, with some potentially experiencing higher levels of anxiety. Therefore, a more thorough investigation of this finding is suggested in future studies.
The findings of the present study also indicated that the odds of having 3VD or LM were higher in patients presenting with dyspnea in addition to pain, compared to those without dyspnea. In this matter too, no previous study was found that specifically compared dyspnea across these three categories. Therefore, we compared the findings with articles that have generally focused on heart attacks. In a study by Medeiros in NSTEMI, patients presenting with dyspnea or fatigue had a worse overall prognosis than those presenting with chest pain or syncope [34]. Abidov et al. examined the prognosis of shortness of breath in patients presenting for cardiac stress testing. They demonstrated in their study that mortality from cardiac and other causes was significantly higher among patients presenting with dyspnea—both in those with known coronary artery disease (CAD) and those without—compared to patients with other symptoms or asymptomatic individuals. Among patients without known CAD, those with dyspnea had a fourfold increased risk of sudden cardiac death compared to asymptomatic individuals, and more than twice the risk compared to patients with typical angina. Dyspnea was associated with a significantly increased risk of mortality in each clinically relevant subgroup and was identified as an independent predictor of cardiac-related death (P < 0.001) as well as all-cause mortality (P < 0.001), even after adjusting for other key variables [35].
Bøtker et al. demonstrated that although the prevalence of dyspnea in patients with myocardial infarction was lower than that of chest pain, the prognosis was significantly worse in those presenting with dyspnea. Patients with dyspnea and confirmed myocardial infarction had higher 30-day and 4-year mortality rates (21% and 60%, respectively) compared to those presenting with chest pain (5.0% and 23%) [31]. Similarly, studies by Boeddinghaus et al. and Marcus et al. identified dyspnea as an independent predictor of mortality in cardiac patients [36, 37]. In addition, Berliner’s study also showed that the presence of dyspnea is associated with an increased risk of mortality [38].
In the present study, patients who experienced shortness of breath were more likely to have LM and 3VD. Given that both conditions are associated with higher mortality rates and poorer prognoses, the findings of this study align with those of the aforementioned research.
Conclusions
LM and 3VD are linked to a poorer prognosis due to extensive myocardial involvement. Diagnosing and managing these conditions quickly remains a challenge. Current clinical guidelines recommend revascularization for all patients with > 50% stenosis of the LM, regardless of symptom status or the degree of ischemic burden. Recognizing the characteristics of 3VD or LM myocardial infarction in patients—whether or not ST-segment changes are present—can aid in early diagnosis. Prompt diagnosis and treatment are crucial to reducing morbidity and mortality, ultimately enhancing survival rates and quality of life for patients with 3VD or LM myocardial infarction. This study highlights the importance of considering 3VD or LM involvement in patients presenting with both dyspnea and chest pain. This study found that individuals who experience both pain and dyspnea have a five times higher chance of developing LM or 3 VD or both together compared to others. Therefore, paying attention to this factor could assist in quick and timely diagnosis. However, given the limitations of the present study, further research is needed to investigate whether clinical symptoms, particularly dyspnea (studies focusing on dyspnea), can improve the triage and categorization of patients, accelerate treatment, and enhance patient prognosis. Generalizability to other populations or settings is necessary further studies and given that the present study is a cross-sectional study and given the limitations of the study, the actual prediction of shortness of breath requires a prospective design.
"VSports app下载" Limitation
Dyspnea was assessed through self-reported patient questionnaires. In future studies, it is recommended to use more accurate and structured instruments to measure shortness of breath. Due to a lack of a sampling frame and pre-defined eligible patient list, purposive sampling was employed. Exclusion of patients with “death or cardiac resuscitation” was another limitation. Because these patients died before angiography, definitive diagnosis of LM/3VD was not possible.
Acknowledgements
The researchers extend their sincere gratitude to the Research Vice Chancellor of Gonabad University of Medical Sciences for their support. They also deeply appreciate the participation and cooperation of all the patients involved in this study.
Abbreviations
- AMI
Acute myocardial infarction
- CAD
Coronary artery disease
- CABG
Coronary artery bypass graft
- CHD
Coronary heart disease
- CVD
cardiovascular disease
- HF
Heart failure
- LAD
The left anterior descending artery
- LM
Left main
- NHANES
National Health and Nutrition Examination Survey
- NSTEMI
Non ST elevation myocardial infarction
- RCA
The right coronary artery
- STEMI
ST elevation myocardial infarction
- VAS
Visual analog scale
- 3VD
Three vessels disease
- LM/3VD
The presence of one of these complications in the patient
- LM & 3VD
The presence of both conditions together in the patient
Authors’ contributions (V体育平台登录)
Author Contributions Statementwe certify that we have participated sufficiently in the intellectual content, conception and design of this work or the analysis and interpretation of the data, as well as the writing of the manuscript, to take public responsibility for it and have agreed to have our name listed as a contributor. we believe the manuscript represents valid work. Neither this manuscript nor one with substantially similar content under our authorship has been published or is being considered for publication elsewhere.Our contribution to this article is as follows: Ibrahim Behnam: Ideation, proposal writing, sampling, article writingMahdi Basiri Moghaddam: Proposal writing, data analysis, Interpretation of findings, article writingZahra Dalir: Data analysis, Interpretation of findings, article writingMehrsa Basiri Moghaddam: Ideation, proposal writing, data analysis, Interpretation of findings, article writing and editing.
"V体育ios版" Funding
There is no funding.
Data availability
No datasets were generated or analysed during the current study.
Declarations
Ethics approval and consent to participate
The ethics committee that approved our study is Regional Ethics Committee in Research of Gonabad University of Medical Sciences. This article is based on a Master’s thesis in Nursing and has been approved under the ethics code IR.GMU.REC.1402.166. The provisions of the Helsinki Declaration and ethical considerations have been adhered to.
Consent for publication
Author consent form is attached.
Competing interests
The authors declare no competing interests.
Footnotes (V体育官网入口)
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
"VSports app下载" Data Availability Statement
No datasets were generated or analysed during the current study.