The prevalence of coronary artery disease in patients presenting with 'non-anginal chest pain'.

Abstract

The National Institute for Health and Care Excellence (NICE) advise against routine testing for coronary artery disease (CAD) in patients with non-anginal chest pain (NACP). This clinical audit sought to establish the prevalence of significant CAD in this cohort using computed tomography angiography (CTCA) and evaluate differences in the prevalence of cardiovascular risk factors between those with and without obstructive coronary disease. Over 23 months, 866 patients with NACP underwent CTCA. Patients were separated into three groups for analysis depending on the degree of CAD on CTCA using the CAD-RADS (Coronary Artery Disease Reporting and Data System) scoring system; no evidence of CAD (group 1), a degree of CAD requiring medical therapy only (group 2), significant CAD defined as a CAD-RADS score 4A/B or 5 (group 3). Cardiovascular risk factors were compared between the groups. We found 11.5% had significant CAD (group 3), 58.3% required medical therapy (group 2) and 30.1% had no CAD (group 1). There were 32 patients who required coronary revascularisation. Patients in group 2 and 3 were more likely to be male (p<0.001) and older (p<0.001) when compared to patients in group 1. Patients in group 3 were more likely to be hypertensive (p=0.008) and have higher Qrisk2 scores (p<0.001) when compared with those in group 1. In conclusion, NICE guidelines for NACP may result in a significant proportion of patients with CAD being underdiagnosed, including some with severe disease requiring revascularisation. This analysis suggests age, male gender, Qrisk2 score and hypertension are predictors of CAD in this cohort.