Characteristics and typicality of chest pain in suspected patients for stable coronary heart disease (Master thesis)

Νάκας, Γεώργιος Κ.

Coronary artery disease (CAD) is among the leading causes of morbidity and mortality in developed countries. Angina is an important clinical symptom for underlying CAD and its characteristics (i.e. typicality) are currently important in identifying patients with significant CAD. However, these associations were shown in populations from older studies that do not match modern treatment and referral strategies. In the present study we aimed to investigate the association of chest pain characteristics with classical cardiovascular risk factors as well as the presence of angiographic CAD in a cohort of patients undergoing coronary angiography for suspected stable CAD in the current era.Consecutive patients undergoing coronary angiography for suspected stable CAD in a single University hospital clinical center were enrolled in our study. Traditional clinical classification of chest pain as typical anginal, atypical anginal and no chest pain was used. The presence of significant angiographic CAD was assessed using standard coronary angiography and the GENSINI score and the SYNTAX score were also calculated to assess the extent of CAD. According to the results of our study, male asymptomatic subjects were referred more often for angiography compared to women. Moreover, the prevalence of asymptomatic patients or typical symptoms did not differ according to the presence of diabetes. Typical symptoms were associated with a higher prevalence of CAD compared to the absence of chest pain. Atypical symptoms were associated with a lower prevalence of CAD compared to the absence of symptoms. Similar associations were observed in diabetic and non diabetic populations. In multivariate analysis, typical angina symptoms remained an independent predictor of CAD. The typicality of symptoms alone could predict the presence of CAD with greater accuracy compared to other classical risk factors or hs-CRP. In multivariate analysis, the addition of these factors to symptoms further improved the predictive accuracy of our model. Finally, in patients with established coronary atherosclerosis (i.e. GENSINI >0) the characteristics of anginal symptoms were not associated with the extent of CAD after adjustment for other risk factors. In conclusion, in a modern cohort of patients referred for coronary angiography for stable CAD, the presence of typical angina symptoms was the most important independent predictor of significant CAD although it was not related to the extent of CAD. Interestingly, diabetes was not associated with greater prevalence of atypical or absence of symptoms and did not influence much the association of symptoms typicality with CAD presence. The relation of atypical symptoms with lower CAD prevalence compared to asymptomatic status probably reflects different management and referral strategies in this group of patients. In the future, prospective data should be collected including more heterogeneous populations and deriving from several centers of reference, so as more valid models to be developed, being thus better applied to the general population.
Alternative title / Subtitle: συσχέτιση με παράγοντες καρδιαγγειακού κινδύνου και την παρουσία και έκταση στεφανιαίας νόσου
correlation with cardiovascular risk factors and the presence and extent of coronary artery disease
Institution and School/Department of submitter: Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής
Subject classification: Θωρακικό άλγος
Στεφανιαία νόσος
Keywords: Θωρακικό άλγος,Στηθάγχη,Στεφανιαία νόσος,Παράγοντες καρδιαγγειακου κινδύνου,Chest pain,Angina pectoris,Coronary artery disease,Cardiovascular risk factors
Appears in Collections:Διατριβές Μεταπτυχιακής Έρευνας (Masters)

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