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Prognostic value of reported chest pain for cardiovascular risk stratification in primary care
David M Leistner1, Jens Klotsche2, Sylvia Palm1
1Department of Internal Medicine III, Cardiology, Goethe-University Frankfurt, Germany.
Insights
Chest pain significantly increases the risk of major adverse cardiovascular events in primary prevention. Combining chest pain assessment with NT-pro-BNP levels improves cardiovascular risk prediction by 40%.
Area of Science:
- Cardiology
- Preventive Medicine
- Biomarkers
Background:
- The prognostic value of chest pain is established in coronary artery disease patients but less defined in primary prevention.
- Contemporary primary prevention strategies can benefit from improved risk stratification tools.
Purpose of the Study:
- To assess the prognostic value of different chest pain presentations in primary prevention.
- To evaluate the utility of NT-pro-BNP in conjunction with chest pain for cardiovascular risk prediction.
Main Methods:
- Post-hoc analysis of the prospective DETECT cohort study involving 5570 subjects free of coronary artery disease.
- Assessment of chest pain history (any, exertional, classical angina) and serum NT-pro-BNP levels.
- 5-year follow-up for major adverse cardiovascular events (MACEs).
Main Results:
- All forms of chest pain were associated with a threefold increased risk of MACEs, independent of cardiovascular risk factors.
- Chest pain had a predictive value for MACEs comparable to a single NT-pro-BNP measurement.
- Combining chest pain and NT-pro-BNP reclassified approximately 40% of subjects' cardiovascular risk.
Conclusions:
- Self-reported chest pain and NT-pro-BNP measurement significantly enhance cardiovascular risk prediction in primary prevention.
- The combined assessment allows for substantial risk reclassification compared to traditional risk factors alone.
Background:
The prognostic significance of chest pain is well established in patients with coronary artery disease, but still ill defined in primary prevention. Therefore, the aim of our analysis was to assess the prognostic value of different forms of chest pain in a large cohort of primary care subjects under the conditions of contemporary modalities of care in primary prevention, including measurement of serum levels of the biomarker NT-pro-BNP.
Design:
We carried out a post-hoc analysis of the prospective DETECT cohort study.
Methods:
In a total of 5570 unselected subjects, free of coronary artery disease, within the 55,518 participants of the cross-sectional DETECT study, we assessed chest pain history by a comprehensive questionnaire and measured serum NT-pro-BNP levels. Three types of chest pain, which were any chest pain, exertional chest pain and classical angina, were defined. Major adverse cardiovascular events (MACEs = cardiovascular death, myocardial infarction, coronary revascularization procedures) were assessed during a 5-year follow-up period.
Results:
During follow-up, 109 subjects experienced a MACE. All types of reported chest pain were associated with an approximately three-fold increased risk for the occurrence of incident MACEs, even after adjusting for cardiovascular risk factors. Any form of reported chest pain had a similar predictive value for MACEs as a one-time measurement of NT-pro-BNP. However, adding a single measurement of NT-pro-BNP and the information on chest pain resulted in reclassification of approximately 40% of subjects, when compared with risk prediction based on established cardiovascular risk factors.
Conclusions:
In primary prevention, self-reported chest pain and a single measurement of NT-pro-BNP substantially improve cardiovascular risk prediction and allow for risk reclassification of approximately 40% of the subjects compared with assessing classical cardiovascular risk factors alone.
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