Key result
Patients with coronary artery disease were significantly less likely to experience chest pain radiating to the neck (OR 0.44) or back (OR 0.48) compared to patients with cardiac syndrome X.
Why the study?
The study aimed to assess whether clinical features from present and past medical history could help predict elective coronary angiography outcomes in patients with typical chest pain.
Do specific chest pain characteristics and medical history predict the presence of obstructive CAD versus Cardiac Syndrome X in patients undergoing elective coronary angiography?
Observational (n=154)
No
Do specific chest pain characteristics and medical history predict the presence of obstructive CAD versus Cardiac Syndrome X in patients undergoing elective coronary angiography?
Odds Ratio: 0.44 (95% CI 0.21–0.91)
p-value: p=0.027
Specific clinical features, such as lack of radiation to the neck/back, dyspnea, dizziness, and migraine, are more predictive of Cardiac Syndrome X than obstructive CAD in patients presenting with typical chest pain.
Clinical history may aid ECA outcome prediction in typical chest pain; leaves open prospective validation before changing referral thresholds.
AIM: This study aimed to assess if clinical remarks gained by analysis of the present and past medical history of patients undergoing elective coronary angiography (ECA) due to typical chest pain can help to predict the outcome of ECA. MATERIAL AND METHODS: One hundred and fifty-four ECA candidates with a history of typical chest were seen on the same day intended for ECA in the cardiac centre of AlShaab Teaching Hospital, Khartoum, Sudan. The details of the present complaints, characteristics of chest pain, past medical and socioeconomic history were recorded from each subject guided by a questionnaire. ECA confirmed CAD in 112 of the studied patients and were considered as the test group. The remaining patients (N = 42) were diagnosed as CSX after exclusion of significant narrowing of the coronary vessels and were considered as the control group. RESULTS: Univariate analysis of pain characteristics among patients undergoing coronary angiography revealed that pain is less likely to radiate to the neck (OR = 0.44, 95% CI = 0.21 - 0.91, P = 0.027) and the back (OR = 0.48, 95% CI = 0.23 - 1.00, P = 0.049) in patients with CAD. Presence of shortness of breathing and/or dizziness significantly decrease the odds of having abnormal coronary angiography (OR = 0.30 and 0.48, 95% CI = 0.12 - 0.77 and 0.22 - 0.92, P = 0.013 and 0.030 respectively). Past history of diabetes mellitus significantly increases the odds of having abnormal coronary angiography (OR = 3.96, 95% CI = 1.68 - 9.30, P = 0.002). In contrast, past medical history of migraine decreases the odds of having positive finding in ECA (OR = 0.31, 95% CI = 0.13 - 0.72, P = 0.006). CONCLUSION: Characteristics of chest pain are comparable in CAD and CSX. However, pain is less likely to radiate to the neck and/or the back in the first group. Presence of dyspnea and dizziness during angina attacks as well as the history of migraine significantly decreases the odds of having abnormal coronary angiography.
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Elhakeem et al. (2019) conducted an observational in Typical chest pain undergoing elective coronary angiography (n=154). Coronary Artery Disease vs. Cardiac Syndrome X was evaluated on Radiation of pain to the neck (OR 0.44, 95% CI 0.21-0.91, p=0.027). Patients with coronary artery disease were significantly less likely to experience chest pain radiating to the neck (OR 0.44) or back (OR 0.48) compared to patients with cardiac syndrome X.
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