Introduction NICE define three key features of typical angina, and patients presenting with only one of these features are described as having ‘non-anginal chest pain’. The latest NICE guidelines advise against routine testing for coronary artery disease (CAD) in this cohort. Despite this, the rapid access chest pain clinic at our institution have continued to investigate these patients. This study sought to establish the prevalence of CAD in this cohort, and evaluate the differences in cardiovascular risk factors between those with and without significant disease.
Methods Between 1st January 2017 and 1st December 2019, patients without prior history of cardiac disease presenting with non-anginal chest pains were referred for coronary computed tomography angiography (CCTA). Calcification scores were recorded using the Coronary Artery Calcium-Data and Reporting System (CAC-DRS) and luminal stenosis was recorded using the Coronary Artery Disease-Reporting and Data System (CAD-RADS). Patients unable to have luminal analysis due to calcium or high heart rates either had stress echocardiography (SE) or invasive coronary angiography (iCA). Patients were deemed as having significant CAD if they had any of the following: CAD-RADS score of 4 or more on CCTA, 4 segments of stress inducible ischaemia on SE or severe stenosis on iCA. Cardiovascular risk factors were then compared between those with and without CAD, to determine if there were any significant differences between the groups.
Results In total, 1078 patients presented with non-anginal chest pains. All patients had CAC-DRS scores and in 872 patients it was possible to record CAD-RADS scores (table 1). Of the 206 patients unable to have luminal analysis, 199 had SE and 7 had iCA. In total, 143 patients (13.3%) were found to have significant CAD on imaging. In total, 34 of these patients had revascularisation (9 patients had bypass grafting and 25 patients had percutaneous coronary intervention). Table 2 shows that patients with significant CAD were more likely to be hypertensive (p=0.004), older (p<0.001) and have a higher Qrisk2 score (p<0.001).
Conclusion Following current NICE guidelines for ‘non-anginal chest pain’ may mean a considerable proportion of patients with underlying CAD are missed, including those with severe lesions requiring revascularisation. Our analysis suggests that age, Qrisk2 score and a history of hypertension are statistically significant predictors of significant CAD in this population.
Conflict of Interest None
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.