Cause analysis of young patients with chest pain and negative results of coronary angiography

Abstract

Objective To reduce the incidence of sudden cardiac death in young individuals with chest pain suspected to be acute coronary syndrome (ACS) and negative results of angiography, and so explored the causes of it. Methods A total of 134 young patients with suspected ACS admitted in PLA general hospital from January 2014 to December 2014 , were checked by coronary angiography. Comparisons of gender, professions, BMI, biochemical variables including glycohemoglobin (HBA1c), triglyceride (TG), C-reactive protein (CRP), troponin T (cTnT), high-density lipoprotein (HDL), brain natriuretic diuresis peptide (BNP)) and cardiac function including interventricular septum thickness, left ventricular posterior wall thickness, left ventricular end-diastolic volume and left ventricular systolic volume, stroke volume, ejection fraction and shortening fraction of left ventricle, E value, A value, E/A value among coronary angiography negative group (n=64), coronary angiography positive group (n=70) and healthy subjects group (n=77) . Quantitative variables were presented as means ± standard deviations, categorical data were presented as absolute values and percentages compared using t-test. One-way ANOVA was used to analyze variance between groups. Results The causes of negative group were found to be coronary atherosclerosis (90.6%), cardiac neurosis (4.7%), cardiomyopathy (1.6%), cardiac syndrome X (1.6%), and other 3.2%. There were 81.1% male and 58.9% officer of civil service management and business service personnel in negative group. The young patients in negative group had higher levels of BMI (P=0.000), total cholesterol (TC) (P=0.000), hypersensitive C-reactive protein (CRP) (P=0.003), cardiac troponin T (cTnT) (P=0.009) and lower high density lipoprotein (HDL) (P=0.000) compared with healthy subjects group. There was no significant difference in level of brain natriuretic peptide (BNP) between negative group and healthy subjects group (P=0.128). There were higher levels of left ventricular ejection fraction (LVEF) (P=0.000) and fractional shortening (FS) (P=0.000), and lower left ventricular end systolic volume (P=0.006) in negative group compared with positive group. Conclusions Coronary atherosclerosis is the major cause of young patients with chest pain suspected acute coronary syndrome (ACS) and with negative results of coronary angiography. Male, high stress occupation, a sedentary job, obesity, hyperglycemia and dyslipidemia are risk factors. Early diagnosis and prevention strategy are mandatory in these specific young individuals. Key words: Young people; Acute coronary syndrome; Sudden cardiac death; Chest pain; Causes; Coronary angiography negative; Biochemical indicators; Gender; Profession; Heart function