Key result
Elevated non-HDL-C linked to ~7.2-fold higher odds of true-positive stress echocardiography in acute chest pain.
Why the study?
Decision points for noninvasive angiography versus functional testing remain undefined in low- and intermediate-risk acute chest pain patients with previously unverified CAD.
Does an elevated non-HDL-C level predict a true positive stress echocardiography result in low- to intermediate-risk patients with acute chest pain and unverified CAD?
Cross-Sectional (n=129)
No
Does an elevated non-HDL-C level predict a true positive stress echocardiography result in low- to intermediate-risk patients with acute chest pain and unverified CAD?
Non-HDL-C >4.42 mmol/L identifies low- to intermediate-risk acute chest pain patients who are more likely to have a true positive stress echocardiogram, potentially optimizing initial test selection.
Answers are grounded in this paper and cite their sources.
Non-HDL-C >4.42 mmol/L was associated with true-positive stress echocardiography; hypothesis-generating for test selection and requires prospective validation.
Background . Clinical suspicion of unstable angina in patients with previously unverified coronary artery disease (CAD) has limited efficacy in decisions whether invasive coronary angiography is necessary. A likelihood-based approach to selecting the optimal diagnostic test in evaluating chest pain offers distinct clinical benefits, but decision points for noninvasive angiography or functional testing for lowand intermediate-risk acute chest pain patients with previously unverified CAD remain undefined. Aim : To find decision-making point to select stress-echocardiography (SE) as the initial test in lowto intermediate-risk acute chest pain patients with previously unverified CAD. Methods. The study included 129 patients, aged 56 ± 11 years, of whom 83 (64%) were male and 97 (75%) had ≥ 3 risk factors for CAD. They underwent exercise SE. The diagnostic performance of SE was analyzed to identify true positive (TP) SE results; reference methods were invasive or noninvasive coronary angiography. TP SE was the target outcome in favor of SE as the initial test. All patients were clustered into phenogroups based on differences in serum triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and atherogenic index (AI). TC, non-HDL-C, and AI were used to determine thresholds for belonging to a phenogroup in which the odds of TP SE were higher. Results . The rate of TP SE was 8%. Patients with TP SE had higher levels of non-HDL-C (p = 0.001) and AI (p = 0.066) compared to the remaining patients. After clustering, 2 phenogroups were identified in the total study population, uniting the 36% of patients with the highest non-HDL-C and AI. The odds ratio for TP SE in this joint group was 7.2 (1.4–36.6). Non-LDL >4.42 mmol/l estimate joint group membership with sensitivity 0.91, specificity 0.88, and area under curve 0.97. Conclusion . Non-HDL-C >4.42 mmol/l may be considered in low to intermediate risk acute chest pain patients with previously unverified CAD as a criterion for using SE as a starting test.
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Abramenko et al. (2025) conducted a cross-sectional in Acute chest pain with previously unverified coronary artery disease (n=129). High non-HDL-C (>4.42 mmol/l) and atherogenic index (Phenogroup 1+2) vs. Lower non-HDL-C and atherogenic index (Phenogroup 3+4) was evaluated on True positive stress echocardiography result (OR 7.2, 95% CI 1.4-36.6, p=0.006). High non-HDL-C (>4.42 mmol/L) predicted a true positive stress echocardiography result with an OR of 7.2 (95% CI 1.4–36.6) in low- to intermediate-risk acute chest pain patients.
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