Diagnostic utility of chest pain characteristics in discriminating obstructive coronary artery disease: A ‘Historic’ Dilemma

Yıl: 2019 Cilt: 8 Sayı: 1 Sayfa Aralığı: 88 - 92 Metin Dili: İngilizce DOI: 10.5455/medscience.2018.07.8882 İndeks Tarihi: 26-09-2019

Diagnostic utility of chest pain characteristics in discriminating obstructive coronary artery disease: A ‘Historic’ Dilemma

Öz:
Chest pain (CP) is the major presenting symptom of coronary artery disease (CAD) wherein history remains to be a fundamental and challenging diagnostic step. Despite the clarity of ‘typical’ CP characteristics in guidelines; interpretation and description of CP by patients are open to wide variations. The aim of this study was to define the components of CP that most closely associate to presence of obstructive CAD and determine the influence of gender on CP features. Herein, consecutive patients with suspected stable CAD who were scheduled for a coronary angiography(CAG) were prospectively enrolled. The data on demographic and pain characteristics were collected by a questionnaire. Patients were categorized into ‘CAD’ and ‘Normal’ groups with respect to presence of obstructive CAD in CAG. Among 402 patients, 86 had chest discomfort or equivalent symptoms but denied ‘CP’. Patients with CAD were more commonly male; with older age, lower BMI, more frequent prior revascularization, clopidogrel use, higher creatinine and lower HDL levels. When classical features of CP such as quality; location, duration, relationship to exertion were compared; stabbing/sharp pain, CP related to cold or emotional stress and CP that radiates to back were significant factors against CAD; while absence of precipitating factors was related to CAD. Yet, none of the features of typical angina pectoris were significantly related to presence of CAD. Determinants of CAD were; prior revascularization (OR= 22.7, p=0.021), body mass index (OR=1.4, p=0.007), clopidogrel use(OR=55.5, p=0.018) and blood glucose (OR=1.02, p=0.046) in women; and age (OR=1.2, p=0.029) was the single predictor of CAD in men. This study demonstrated no association between classical features of typical CP and presence of CAD in patients with stable angina pectoris. Clinical factors that influenced presence of CAD in different genders were also different.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • Task Force Members, Montalescot G, Sechtem U, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34:2949–3003.
  • Lenfant C. Chest pain of cardiac and noncardiac origin. Metabolism. 2010;59:41-6.
  • Khan IA, Mehta NJ. Initial historical descriptions of the angina pectoris. J Emerg Med. 2002;22:295-8.
  • Carlton EW, Than M, Cullen L, et al. Chest pain typicality’ in suspected acute coronary syndromes and the impact of clinical experience. Am J Med. 2015;128:1109-16.
  • das Virgens CM, Lemos L, Noya-Rabelo M, et al. Accuracy of gestalt perception of acute chest pain in predictingcoronary artery disease. World J Cardiol. 2017:26;9:241-7.
  • Sepehrvand N, Zheng Y, Armstrong PW, et al. Identifying low risk patients for early discharge from emergency department without using subjective descriptions of chest pain: insights from providing rapid out of hospital acute cardiovascular treatment (PROACT) 3 and 4 Trials. Acad Emerg Med. 2017;24:691-700.
  • Tamura A, Naono S, Torigoe K, et al. Gender differences in symptoms during 60-second balloon occlusion of the coronary artery. Am J Cardiol. 2013;111:1751-4.
  • Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med. 1979;300:1350-8.
  • Rovai D, Neglia D, Lorenzoni V, et al. Limitations of chest pain categorization models to predict coronary artery disease. Am J Cardiol. 2015;116:504-7.
  • Wheeler A, Schrader G, Tucker G, et al. Prevalence of depression in patients with chest pain and non-obstructive coronary artery disease. Am J Cardiol. 2013;112:656-9.
  • Mommersteeg PM, Pot I, Aarnoudse W, et al. Type D personality and patientperceived health in nonsignificant coronary artery disease: the TWeesteden mIld STenosis (TWIST) study. Qual Life Res. 2013;22:2041-50.
  • Tamura A, Naono S, Torigoe K, et al .Gender differences in symptoms during 60-second balloon occlusion of the coronary artery. Am J Cardiol. 2013;111:1751-4.
  • Philpott S, Boynton PM, Feder G, et al. Gender differences in descriptions of angina symptoms and health problems immediately prior to angiography: the ACRE study. Appropriateness of coronary revascularization study. Soc Sci Med. 2001;52:1565-75.
  • Granot M, Goldstein-Ferber S, Azzam ZS. Gender differences in the perception of chest pain. J Pain Symptom Manage. 2004;27:149-55.
  • Parasca CA, Head SJ, Milojevic M, et al. Incidence, characteristics, predictors, and outcomes of repeat revascularization after percutaneous coronary intervention and coronary artery bypass grafting: The SYNTAX Trial at 5 Years. JACC Cardiovasc Interv. 2016;9:2493-507.
  • Braun N, Gomes F, Schütz P. “The obesity paradox” in disease: Is the protective effect of obesity true? Swiss Med Wkly. 2015;145:142-65.
  • Lavie CJ, McAuley PA, Church TS, et al. Obesity and cardiovascular diseases: implications regarding fitness, fatness, and severity in the obesity paradox. J Am Coll Cardiol. 2014;63:1345-54.
  • Goyal A, Nimmakayala KR, Zonszein J. Is there a paradox in obesity? Cardiol Rev. 2014;22:163-70.
  • Grosmaitre P, Le Vavasseur O, Yachouh E, et al. Significance of atypical symptoms for the diagnosis and management of myocardial infarction in elderly patients admitted to emergency departments. Arch Cardiovasc Dis. 2013;106:586-92.
APA ÖZKARAMANLI GÜR D (2019). Diagnostic utility of chest pain characteristics in discriminating obstructive coronary artery disease: A ‘Historic’ Dilemma. , 88 - 92. 10.5455/medscience.2018.07.8882
Chicago ÖZKARAMANLI GÜR Demet Diagnostic utility of chest pain characteristics in discriminating obstructive coronary artery disease: A ‘Historic’ Dilemma. (2019): 88 - 92. 10.5455/medscience.2018.07.8882
MLA ÖZKARAMANLI GÜR Demet Diagnostic utility of chest pain characteristics in discriminating obstructive coronary artery disease: A ‘Historic’ Dilemma. , 2019, ss.88 - 92. 10.5455/medscience.2018.07.8882
AMA ÖZKARAMANLI GÜR D Diagnostic utility of chest pain characteristics in discriminating obstructive coronary artery disease: A ‘Historic’ Dilemma. . 2019; 88 - 92. 10.5455/medscience.2018.07.8882
Vancouver ÖZKARAMANLI GÜR D Diagnostic utility of chest pain characteristics in discriminating obstructive coronary artery disease: A ‘Historic’ Dilemma. . 2019; 88 - 92. 10.5455/medscience.2018.07.8882
IEEE ÖZKARAMANLI GÜR D "Diagnostic utility of chest pain characteristics in discriminating obstructive coronary artery disease: A ‘Historic’ Dilemma." , ss.88 - 92, 2019. 10.5455/medscience.2018.07.8882
ISNAD ÖZKARAMANLI GÜR, Demet. "Diagnostic utility of chest pain characteristics in discriminating obstructive coronary artery disease: A ‘Historic’ Dilemma". (2019), 88-92. https://doi.org/10.5455/medscience.2018.07.8882
APA ÖZKARAMANLI GÜR D (2019). Diagnostic utility of chest pain characteristics in discriminating obstructive coronary artery disease: A ‘Historic’ Dilemma. Medicine Science, 8(1), 88 - 92. 10.5455/medscience.2018.07.8882
Chicago ÖZKARAMANLI GÜR Demet Diagnostic utility of chest pain characteristics in discriminating obstructive coronary artery disease: A ‘Historic’ Dilemma. Medicine Science 8, no.1 (2019): 88 - 92. 10.5455/medscience.2018.07.8882
MLA ÖZKARAMANLI GÜR Demet Diagnostic utility of chest pain characteristics in discriminating obstructive coronary artery disease: A ‘Historic’ Dilemma. Medicine Science, vol.8, no.1, 2019, ss.88 - 92. 10.5455/medscience.2018.07.8882
AMA ÖZKARAMANLI GÜR D Diagnostic utility of chest pain characteristics in discriminating obstructive coronary artery disease: A ‘Historic’ Dilemma. Medicine Science. 2019; 8(1): 88 - 92. 10.5455/medscience.2018.07.8882
Vancouver ÖZKARAMANLI GÜR D Diagnostic utility of chest pain characteristics in discriminating obstructive coronary artery disease: A ‘Historic’ Dilemma. Medicine Science. 2019; 8(1): 88 - 92. 10.5455/medscience.2018.07.8882
IEEE ÖZKARAMANLI GÜR D "Diagnostic utility of chest pain characteristics in discriminating obstructive coronary artery disease: A ‘Historic’ Dilemma." Medicine Science, 8, ss.88 - 92, 2019. 10.5455/medscience.2018.07.8882
ISNAD ÖZKARAMANLI GÜR, Demet. "Diagnostic utility of chest pain characteristics in discriminating obstructive coronary artery disease: A ‘Historic’ Dilemma". Medicine Science 8/1 (2019), 88-92. https://doi.org/10.5455/medscience.2018.07.8882