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[Angiographic results of "atypical" chest pain]
Johann Auer1, Robert Berent, Thomas Weber
1II. Interne Abteilung mit Kardiologie und internistische Intensivemedizin, Allegmeines Offentliches Krankenhaus der Barmherzigen, Schwestern vom Heiligen Kreuz Wels, Austria. johann.auer@khwels.at
Insights
Coronary angiography is appropriate for patients with atypical chest pain and inconclusive noninvasive tests. Nearly half of these patients showed significant coronary artery disease, indicating the need for this diagnostic procedure.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Coronary angiography is an accurate method for diagnosing coronary artery disease (CAD).
- Clinical evaluation and noninvasive tests for CAD have limited sensitivity (10-30% inconsistency).
- Coronary angiography is invasive and costly, necessitating careful patient selection.
Purpose of the Study:
- To evaluate the utility of coronary angiography in patients with "atypical" chest pain.
- To assess the prevalence of coronary artery disease in patients with inconclusive noninvasive testing.
Main Methods:
- Retrospective analysis of 1,000 consecutive patients undergoing coronary angiography.
- Focus on 49 patients referred with "atypical" chest pain and inconsistent noninvasive results.
Main Results:
- 42.9% of patients with atypical chest pain had coronary artery disease (stenosis > 50%).
- Normal coronary arteries were found in 42.9% of these patients.
- Men were more likely than women to have significant coronary artery disease (50% vs 29.4%, p < 0.01).
Conclusions:
- Coronary angiography is appropriate for patients with atypical chest pain and inconclusive noninvasive testing.
- A significant proportion of patients with atypical chest pain have underlying coronary artery disease.
- Angiographic evaluation aids in the diagnosis of CAD in symptomatic patients with ambiguous noninvasive findings.
Background And Aims:
Coronary angiography permits evaluation of coronary artery morphology and coronary pathology. It represents an accurate method of defining stenotic coronary lesions. Chest pain may be caused by coronary artery disease as well as by other cardiac and noncardiac disorders. However, sensitivity of clinical evaluation and noninvasive diagnostic assessment in detection of coronary artery disease is limited. Noninvasive diagnostic strategies give inconsistent results in about 10-30%. Here coronary angiography is regarded as an accurate method for appropriate diagnosis. Ist sophisticated apparatus, cost, and invasiveness necessitate well-considered application of this procedure. Therefore, it appears important to analyze coronary angiograms in patients with the referral diagnosis of "atypical" chest pain with inconsistent noninvasive testing or impossibility to perform noninvasive assessment.
Patients And Methods:
We analyzed records of 1,000 consecutive patients (625 men, 375 women, mean age 63.1 years), who underwent coronary angiography at our institution from January 5, 1998 to May 5, 1998.
Results:
49 patients (17 women, 32 men; mean age 59 years) were referred due to "atypical" chest pain. 21 (42.9%, nine women, twelve men) of these 49 patients had normal coronary arteries at angiography. 21 (42.9%) patients showed coronary artery disease with a diameter stenosis > 50%. In seven (14.2%) patients, coronary sclerosis with a diameter stenosis < 50% could be observed. Only five (29.4%) of the 17 women but 16 of the 32 men (50%) had coronary artery disease with a diameter stenosis > 50% (p < 0.01).
Conclusions:
In unselected patients referred for coronary angiography due to "atypical" chest pain and inconsistent noninvasive testing or impossibility to perform noninvasive assessment. 42.9% had coronary artery disease with a diameter stenosis > 50%. Angiographic evaluation of symptomatic patients with "atypical" signs and symptoms and inconsistent noninvasive testing seems to be appropriate.