Bilateral Anterior Tragal Crease Is Associated With Coronary Revascularization in Patients With Stable Angina
Mehmet Kamil Teber1, Mehmet Zafer Aydın1
1Department of Cardiology, Kayseri City Hospital, Turkey.
Insights
A bilateral anterior tragal crease (ATC) was associated with coronary revascularization in stable angina patients. This simple physical finding may indicate increased coronary atherosclerotic burden, warranting further research.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Stable angina pectoris is a frequent manifestation of chronic coronary syndrome.
- Physical examination findings can aid cardiovascular risk assessment.
- The anterior tragal crease (ATC) is a potential, yet understudied, physical marker.
Purpose of the Study:
- To investigate the association between bilateral anterior tragal crease (ATC) and the need for coronary revascularization in patients with stable angina pectoris.
- To determine if ATC can serve as an independent predictor of coronary artery disease severity.
- To assess the added value of ATC in clinical risk prediction models.
Main Methods:
- A cohort of 862 consecutive patients with stable angina pectoris were assessed for bilateral ATC.
- Coronary angiography was performed based on clinical indications.
- Multivariable logistic regression and receiver operating characteristic (ROC) analyses were used to evaluate the association and predictive value of ATC.
Main Results:
- Coronary revascularization was performed in 15.5% of the patients.
- Bilateral ATC was significantly more prevalent in patients who underwent revascularization (OR 1.67, 95% CI 1.02-2.73, P=.041).
- Adding ATC to a clinical model provided minimal improvement in discrimination (AUC 0.746 vs 0.744).
Conclusions:
- Bilateral ATC is independently associated with coronary revascularization in stable angina patients.
- ATC may serve as a simple physical sign linked to coronary atherosclerotic burden.
- Further validation is needed to establish the clinical utility of ATC in cardiovascular risk stratification.
Abstract:
Stable angina pectoris is a common manifestation of chronic coronary syndrome, and simple physical examination findings may provide additional information for cardiovascular risk assessment. This study investigated the association between bilateral anterior tragal crease (ATC) and coronary revascularization in patients presenting with stable angina pectoris. A total of 862 consecutive patients underwent standardized assessment for bilateral ATC. Coronary angiography and subsequent management were performed according to contemporary guidelines when clinically indicated. The primary outcome was coronary revascularization. Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed. Coronary revascularization was performed in 134 patients (15.5%). Bilateral ATC was significantly more common among patients who underwent revascularization and remained independently associated with revascularization after adjustment for conventional cardiovascular risk factors (odds ratio [OR] 1.67, 95% confidence Interval [CI] 1.02- 2.73; P = .041). ATC alone demonstrated modest discrimination (area under the curve [AUC] 0.614). A clinical model showed good discrimination (AUC 0.744), with a minimal improvement after adding ATC (AUC 0.746; P = .732). ATC may represent a simple physical examination finding associated with coronary atherosclerotic burden, although its clinical utility requires further validation.
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