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

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography Pub Date : 2025-03-01 DOI:10.1016/j.jcct.2025.01.004

Oliver Buchhave Pedersen , Laust Dupont Rasmussen , Louise Nissen , June Anita Ejlersen , Jesper Mortensen , Lars Christian Gormsen , Ashkan Eftekhari , Jelmer Westra , Evald Høj Christiansen , Daniel B. Mark , Morten Bøttcher , Pamela S. Douglas , Simon Winther

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引用次数: 0

Abstract

Background

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

Objectives

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

Methods

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.

Results

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.

Conclusions

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.

Abstract Image

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疑似冠状动脉疾病患者症状特征与疾病严重程度的关系

背景：疑似阻塞性冠状动脉疾病（CAD）患者的自述症状与诊断检查结果经常存在差异。目的：量化疑似阻塞性CAD患者报告的症状与严重狭窄诊断之间的关系。方法：对两组有阻塞性CAD新发症状的患者进行评估。通过典型、部位、类型、劳累/应激因素以及休息/硝酸甘油缓解来评估胸部不适。患者接受非侵入性诊断测试（冠状动脉计算机断层血管造影（CCTA）或功能测试），然后进行测试结果驱动的侵入性冠状动脉血管造影（ICA）。严重狭窄定义为ICA上直径狭窄≥70%。敏感性分析包括CCTA狭窄、功能异常和血运重建术。结果：14410例患者中，2093例（14.5%）被转诊为ICA， 765例（5.3%）被诊断为严重狭窄。典型心绞痛患者（n = 224）被诊断为ICA严重狭窄的几率（OR和95% ci: 2.84[2.40-3.34]）高于非典型或非心绞痛症状患者。在诊断为ICA严重狭窄的患者中，有运动/应激因素的患者(n = 418；OR [95% CI]: 2.50[2.16-2.90])和休息/硝酸甘油缓解(n = 318, 2.28；[1.96-2.65])的患病几率高于未患病者。报告压力或烧灼痛的患者有较高的几率出现严重的狭窄。关联在性别、年龄组和敏感性参考文献中是一致的。结论：劳累/压力相关的胸部不适和休息/硝酸甘油缓解增加了疑似CAD患者在测试结果驱动的ICA中发生严重狭窄的几率，而胸痛的位置和类型相关性较小，性别和年龄组之间没有差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiovascular Computed Tomography CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

7.50

自引率

14.80%

发文量

212

审稿时长

40 days

期刊介绍： The Journal of Cardiovascular Computed Tomography is a unique peer-review journal that integrates the entire international cardiovascular CT community including cardiologist and radiologists, from basic to clinical academic researchers, to private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our cardiovascular imaging community across the world. The goal of the journal is to advance the field of cardiovascular CT as the leading cardiovascular CT journal, attracting seminal work in the field with rapid and timely dissemination in electronic and print media.