Prognostic value of neopterin levels in treated patients with hypertension and chest pain but without obstructive coronary artery disease

AbstractIdentification of obstructive coronary artery disease (OCAD) in patients with chest pain is a clinical challenge. The value of corrected QT interval (QTc) for the prediction of OCAD has yet to be established. We consecutively enrolled 1741 patients with suspected angina. The presence of obstructive OCAD was defined as ≥ 50% diameter stenosis by coronary angiography. The pre-test probability was evaluated by combining QTc prolongation with the CAD Consortium clinical score (CAD2) and the updated Diamond-Forrester (UDF) score. OCAD was detected in 661 patients (38.0%). QTc was longer in patients with OCAD compared with those without OCAD (444 ± 34 vs. 429 ± 28 ms, p < 0.001). QTc was increased by the severity of OCAD (P < 0.001). QTc prolongation was associated with OCAD (odds ratio (OR), 2.27; 95% confidence interval (CI), 1.81–2.85). With QTc, the C-statistics increased significantly from 0.68 (95% CI 0.66–0.71) to 0.76 (95% CI 0.74–0.78) in the CAD2 and from 0.64 (95% CI 0.62–0.67) to 0.74 (95% CI 0.72–0.77) in the UDF score, respectively. QT prolongation predicted the presence of OCAD and the QTc improved model performance to predict OCAD compared with CAD2 or UDF scores in patients with suspected angina.

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Abstract P322: Health Status of Stable Patients With Obstructive or Non-Obstructive Coronary Artery Disease Compared With Healthy Controls

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap322 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Rosanna Tavella ◽

Natalie Cutri ◽

John F Beltrame

Keyword(s):

Quality Of Life ◽

Coronary Artery Disease ◽

Chest Pain ◽

Coronary Artery ◽

Obstructive Coronary Artery Disease ◽

Summary Score ◽

Healthy Controls ◽

Sf 36 ◽

Artery Disease

BACKGROUND. Patients with chest pain and no evidence of obstructive coronary artery disease on angiography (NoCAD) are frequently considered not to have significant pathology and their symptoms trivialized. This study compared the health status of patients with NoCAD, obstructive coronary artery disease (CAD) and healthy subjects. METHOD. Patients undergoing angiography within the preceding 12 months for the investigation of chest pain were categorized as NoCAD or CAD on the basis of the angiographic findings and completed a health-related quality of life instrument, the Short Form-36 (SF-36). These were compared with a ‘healthy control’ group that were randomly selected from the electronic white pages and recruited if they had no self-reported history of cardiovascular disease. Cross sectional comparisons between the three groups were age adjusted and performed using liner regression. RESULTS. As shown in the table below, the healthy controls were significantly younger and therefore comparison of SF36 scores were age adjusted. All SF-36 sub-scales (except for bodily pain) and summary scores (see table ), were significantly lower in the CAD and NoCAD groups compared to the healthy controls. There were no differences in SF-36 scores between NoCAD and CAD. CONCLUSION. Compared with a healthy population, patients with stable CAD and NoCAD have significantly poorer quality of life asF-36. Future management strategies need to address the health outcomes in these patients. Healthy Controls (n = 3168) NoCAD (n = 320) CAD (n = 828) Age 52 ± 15 57 ± 12 * 62 ± 11 # SF-36: Physical Summary Score 49 ± 10 41 ± 11 * 41 ± 11 # SF-36: Mental Summary Score 51 ± 10 46 ± 11 * 46 ± 11 # * p <0.01 for healthy controls vs NoCAD, # p <0.01 for healthy controls vs CAD

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Presence of Recent Chest Pain in Patients with Non-Obstructive Coronary Artery Disease

Heart Lung and Circulation ◽

10.1016/j.hlc.2010.06.743 ◽

2010 ◽

Vol 19 ◽

pp. S33-S34

Author(s):

R. Tavella ◽

C. Wong ◽

S. Cherian ◽

J. Beltrame

Keyword(s):

Coronary Artery Disease ◽

Chest Pain ◽

Coronary Artery ◽

Obstructive Coronary Artery Disease ◽

Artery Disease

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Prognostic Value of Coronary Artery Disease–Reporting and Data System Score for Major Adverse Cardiac Events in Patients Attending the Emergency Department With Acute Chest Pain

Journal of Computer Assisted Tomography ◽

10.1097/rct.0000000000001153 ◽

2021 ◽

Vol 45 (3) ◽

pp. 395-402

Author(s):

Jiwoo Park ◽

Jin Hur ◽

Kyunghwa Han ◽

Dong Jin Im ◽

Kye Ho Lee ◽

...

Keyword(s):

Coronary Artery Disease ◽

Emergency Department ◽

Chest Pain ◽

Coronary Artery ◽

Prognostic Value ◽

Acute Chest Pain ◽

Data System ◽

Cardiac Events ◽

Adverse Cardiac Events ◽

Artery Disease

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A COMPARATIVE ANALYSIS OF CLINICAL PREDICTION MODELS VERSUS A CLINICIAN'S ASSESSMENT FOR THE PREDICTION OF OBSTRUCTIVE CORONARY ARTERY DISEASE IN PATIENTS WITH CHEST PAIN

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(18)30627-2 ◽

2018 ◽

Vol 71 (11) ◽

pp. A86

Author(s):

Jean Ho ◽

Alexander Ivanov ◽

Pavan Patel ◽

Natalia Crenesse-Cozien ◽

Saadat Khan ◽

...

Keyword(s):

Coronary Artery Disease ◽

Comparative Analysis ◽

Chest Pain ◽

Coronary Artery ◽

Prediction Models ◽

Obstructive Coronary Artery Disease ◽

Clinical Prediction ◽

Clinical Prediction Models ◽

Artery Disease

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Clinical risk factors and atherosclerotic plaque extent to define risk for major events in patients without obstructive coronary artery disease: the long-term coronary computed tomography angiography CONFIRM registry

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez322 ◽

2020 ◽

Vol 21 (5) ◽

pp. 479-488 ◽

Cited By ~ 3

Author(s):

Alexander R van Rosendael ◽

A Maxim Bax ◽

Jeff M Smit ◽

Inge J van den Hoogen ◽

Xiaoyue Ma ◽

...

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Computed Tomography Angiography ◽

Prognostic Value ◽

Coronary Computed Tomography Angiography ◽

Obstructive Coronary Artery Disease ◽

Artery Disease

Abstract Aims In patients without obstructive coronary artery disease (CAD), we examined the prognostic value of risk factors and atherosclerotic extent. Methods and results Patients from the long-term CONFIRM registry without prior CAD and without obstructive (≥50%) stenosis were included. Within the groups of normal coronary computed tomography angiography (CCTA) (N = 1849) and non-obstructive CAD (N = 1698), the prognostic value of traditional clinical risk factors and atherosclerotic extent (segment involvement score, SIS) was assessed with Cox models. Major adverse cardiac events (MACE) were defined as all-cause mortality, non-fatal myocardial infarction, or late revascularization. In total, 3547 patients were included (age 57.9 ± 12.1 years, 57.8% male), experiencing 460 MACE during 5.4 years of follow-up. Age, body mass index, hypertension, and diabetes were the clinical variables associated with increased MACE risk, but the magnitude of risk was higher for CCTA defined atherosclerotic extent; adjusted hazard ratio (HR) for SIS >5 was 3.4 (95% confidence interval [CI] 2.3–4.9) while HR for diabetes and hypertension were 1.7 (95% CI 1.3–2.2) and 1.4 (95% CI 1.1–1.7), respectively. Exclusion of revascularization as endpoint did not modify the results. In normal CCTA, presence of ≥1 traditional risk factors did not worsen prognosis (log-rank P = 0.248), while it did in non-obstructive CAD (log-rank P = 0.025). Adjusted for SIS, hypertension and diabetes predicted MACE risk in non-obstructive CAD, while diabetes did not increase risk in absence of CAD (P-interaction = 0.004). Conclusion Among patients without obstructive CAD, the extent of CAD provides more prognostic information for MACE than traditional cardiovascular risk factors. An interaction was observed between risk factors and CAD burden, suggesting synergistic effects of both.

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Gender in cardiovascular medicine: chest pain and coronary artery disease

European Heart Journal ◽

10.1093/eurheartj/ehz784 ◽

2019 ◽

Cited By ~ 2

Author(s):

Puja K Mehta ◽

Courtney Bess ◽

Suzette Elias-Smale ◽

Viola Vaccarino ◽

Arshed Quyyumi ◽

...

Keyword(s):

Coronary Artery Disease ◽

Chest Pain ◽

Coronary Artery ◽

Visceral Pain ◽

Obstructive Coronary Artery Disease ◽

Coronary Intervention ◽

Delay In Diagnosis ◽

Cardiac Autonomic Nervous System ◽

Artery Disease ◽

Pain Symptoms

Abstract Ischaemic heart disease (IHD) remains the leading cause of morbidity and mortality among women and men yet women are more often underdiagnosed, have a delay in diagnosis, and/or receive suboptimal treatment. An implicit gender-bias with regard to lack of recognition of sex-related differences in presentation of IHD may, in part, explain these differences in women compared with men. Indeed, existing knowledge demonstrates that angina does not commonly relate to obstructive coronary artery disease (CAD). Emerging knowledge supports an inclusive approach to chest pain symptoms in women, as well as a more thoughtful consideration of percutaneous coronary intervention for angina in stable obstructive CAD, to avoid chasing our tails. Emerging knowledge regarding the cardiac autonomic nervous system and visceral pain pathways in patients with and without obstructive CAD offers explanatory mechanisms for angina. Interdisciplinary investigation approaches that involve cardiologists, biobehavioural specialists, and anaesthesia/pain specialists to improve angina treatment should be pursued.

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