Clinical Predictors Of Coronary Heart Disease In Patients With Chest Pain

BACKGROUNDThe reporting of chest pain is very common in clinical practice. In 2000, an estimated 8.9 million trips to physician offices in the United States—1% of the total—were prompted by chest pain and related symptoms. That same year, an estimated 5.8 million hospital emergency department visits—5.4% of the total—were prompted by reports of chest pain. Though most of the patients with chest pain were noncardiac disease, but acute myocardial infarction (AMI) is the major cause of death in this kind of patients.The diagnosis of AMI depends on ECG, biochemical markers and clinical symptom. But we had found that the negative ofECG and biochemical markers were not indicating the patients didn't have coronary heart disease. Many of these patients, although considered to be at low or intermediate risk for ACS, are admitted for further evaluation to various in-hospital facilities including medical departments. This policy results in crowding and entails enormous costs worldwide.The purpose of this study is to identify prospectively the clinical symptoms that could independently pre(?)ict coronary heart disease in patients with chest pain.OBJECTS AND METHODSCollected patients who complained of chest pain and admit in the Cardiac Department of Sir Run Run Shaw Hospital from October 2006 to January 2007 for coronary angiography. Before the coronary angiography, each patient was required to complete a structured questionnaire. The questions were designed to elicit information on various patient-related variables, including the clinical data and the symptom of chest pain. The level of serum cholesterol was checked. After the coronary angiography, the patients were grouping into the positive or the negative groups. The clinical data and the symptom of chest pain were compared between the groups.RESULTS63 cases underwent coronary angiography from October 2006 to January 2007 were analyzed. Two groups were identified for the consequence of the coronary angiography, just named positive group (29 patients, 46.03%) and negative group (34 patients, 53.97%).The education, job and the level of serum cholesterol were significantly different between the positive group and negative group (P<0.05). The persistence time of chest pain for 5 to 30 minutes, the exertion inducing chest pain and chest pain accompany by scare were significantly different between the positive group and negative group (P<0.05).Variables most significantly predictive of coronary heart disease resulted: the persistence time of chest pain for 5 to 30 minutes (OR 2.95; 95% CI 1.05-8.35; P=0.038), the exertion inducing chest pain (OR 6.78; 95% CI 1.70-27.00; P=0.008), the emotion inducing chest pain (OR 0.30; 95% CI 0.09-1.01; P=0.008), and chest pain accompany by scare (OR 0.00; 95% CI 0.00; P<0.001).CONCLUSIONS1. The persistence time of chest pain for 5 to 30 minutes and the exertion inducing chest pain may indicate the diagnosis of coronary heart disease, coronary angiography can help to make a definite diagnosis;2. The emotion inducing chest pain and chest pain accompany by scare may caused by anxiety and panic disorder.