Association between symptom characteristics and disease severity in patients suspected of coronary artery disease

Discrepancies often exist between patient-reported symptoms and diagnostic test findings in patients with suspected obstructive coronary artery disease (CAD).

To quantify the association between patient-reported symptoms and the diagnosis of severe stenosis in patients with suspected obstructive CAD.

Two large-scale cohorts of patients with new-onset symptoms suggestive of obstructive CAD were evaluated. Chest discomfort was assessed by typicality, location, type, exertional/stress factors, and relief with rest/nitroglycerine. Patients underwent non-invasive diagnostic testing (coronary computed tomographic angiography (CCTA) or functional testing), followed by test-result-driven invasive coronary angiography (ICA). Severe stenosis was defined as ≥70 ​% diameter stenosis on ICA. Sensitivity analyses included CCTA stenosis, functional abnormalities, and revascularization.

Of 14,410 patients, 2093 (14.5 ​%) were referred for ICA, and 765 (5.3 ​%) were diagnosed with severe stenosis. Patients with typical angina (n ​= ​224) had higher odds of being diagnosed with severe stenosis on ICA (OR and 95 ​% CIs: 2.84 [2.40-3.34]) than those with atypical or non-anginal symptoms. In patients diagnosed with severe stenosis on ICA, those with exertional/stress factors (n ​= ​418; OR [95 ​% CI]: 2.50 [2.16-2.90]) and relief with rest/nitroglycerine (n ​= ​318, 2.28; [1.96-2.65]) had higher odds compared to those without. Patients reporting pressure or burning pain had higher odds of severe stenosis. Associations were consistent across sex and age groups, and sensitivity references.

Exertional/stress-related chest discomfort and relief with rest/nitroglycerine increased the odds of severe stenosis in patients with suspected CAD undergoing test-result-driven ICA, while location and type of chest pain were less associated, with no differences across sex or age groups.