P63 THE EQUIVOCAL AND DANGEROUS CLASSIFICATION OF STABLE CHEST PAIN

Abstract

Abstract Background The classification of suspected anginal stable chest pain into typical, atypical, and non anginal is equivocal and may lead to patient perceptions and physician decisions that do not match the importance of the clinical picture. The study compares the clinical and ischemic burden with that of the cardiovascular risk. Methods Over 15 years, 3588 outpatients, >35 years old (mean 64±9, female 55%) were evaluated for stable chest pain. 290 patients with findings indicative of ischemic heart disease, heart failure, cardiomyopathy, valvular disease were excluded. In the others we applied the classification of typical, atypical and nonanginal pain (Table 1). All were evaluated for the presence of HEART score risk factors (smoking, obesity, family history of cardiovascular events, hypertension, diabetes, hypercholesterolemia) as well as age. All patients with typical or atypical angina and those with non–anginal pain according to the doctor‘s judgment performed functional tests to search for ischemia. Results In Table 2 we find the results of the classification of chest pain and the positivity of the functional test. In Table 3 we have the major events at follow–up stratified according to the initial assessment of chest pain. Table 4 stratifies events according to risk factors and age. Prognosis and event rate differ significantly only when stratified by risk factors and age. Approximately 1% presented a clinical event regardless of the type of pain and the presence of ischemia and 87% of the events involved patients with ≥ 3 risk factors or heavy smokers. 9% of heavy smokers aged <65 years had a major event and are the highest risk group with a peak of 12.5% ​​in those with atypical pain. Conclusions The traditional classification of stable chest pain is dangerous and misleading, both for the identification of ischemia and prognosis, which appears to be linked to the burden of cardiovascular risk and above all to cigarette smoking in patients aged <65 years, rather than the clinical and ischemic burden. It will be necessary to evaluate whether the anatomical burden for the search for high–risk coronary lesions improves the prognosis with an added value with respect to the treatment of lifestyles and risk factors.