Stable atypical chest pain with negative anatomical or functional diagnostic test: Diagnosis no matter what or prevention at any cost?
Chest Pain
/ diagnosis
Computed Tomography Angiography
/ methods
Coronary Angiography
/ methods
Coronary Artery Disease
/ complications
Diagnosis, Differential
Echocardiography, Stress
/ methods
Electrocardiography
Female
Follow-Up Studies
Forecasting
Humans
Incidence
Italy
/ epidemiology
Male
Middle Aged
Retrospective Studies
Risk Assessment
/ methods
Risk Factors
Survival Rate
/ trends
anatomical testing
functional stress testing
modifiable lifestyle factor control
stable atypical chest pain
Journal
Clinical cardiology
ISSN: 1932-8737
Titre abrégé: Clin Cardiol
Pays: United States
ID NLM: 7903272
Informations de publication
Date de publication:
Oct 2019
Oct 2019
Historique:
received:
06
06
2019
revised:
13
08
2019
accepted:
14
08
2019
pubmed:
23
8
2019
medline:
18
2
2020
entrez:
22
8
2019
Statut:
ppublish
Résumé
Approximately 1% to 2% of patients with stable atypical chest pain (SACP) experienced a major coronary event, even after a negative functional or anatomical test. Over the past 15 years, 1706 patients with SACP evaluated in our clinics underwent functional stress testing or coronary computed tomographic angiography (CTA). In these patients, we also assessed the presence of three major modifiable lifestyle-related risk factors (cigarette smoking, low intake of fruit and vegetables, and physical inactivity). Patients were stratified according to the presence of at least one risky lifestyle factor or no risky lifestyle factors. Functional or anatomical tests were positive in 170 patients (10%). We followed the remaining 1536 patients with negative tests for 1 year to evaluate the incidence of major coronary events. The percentage of patients reporting major coronary events was 1.2% in the group with risky lifestyles and 0.2% in the non-risky lifestyle group (P < .01). Events were more common in smokers. Patients with SACP, when functional or anatomical tests are negative, have a residual risk of fatal and non-fatal cardiovascular events of 1% at 1 year of follow-up. People with incorrect lifestyles, especially smokers, have a higher risk of events. We think that in this population, a more effective intervention on lifestyles could be the key to reduce major cardiovascular events.
Sections du résumé
BACKGROUND
BACKGROUND
Approximately 1% to 2% of patients with stable atypical chest pain (SACP) experienced a major coronary event, even after a negative functional or anatomical test.
METHODS
METHODS
Over the past 15 years, 1706 patients with SACP evaluated in our clinics underwent functional stress testing or coronary computed tomographic angiography (CTA). In these patients, we also assessed the presence of three major modifiable lifestyle-related risk factors (cigarette smoking, low intake of fruit and vegetables, and physical inactivity). Patients were stratified according to the presence of at least one risky lifestyle factor or no risky lifestyle factors. Functional or anatomical tests were positive in 170 patients (10%). We followed the remaining 1536 patients with negative tests for 1 year to evaluate the incidence of major coronary events.
RESULTS
RESULTS
The percentage of patients reporting major coronary events was 1.2% in the group with risky lifestyles and 0.2% in the non-risky lifestyle group (P < .01). Events were more common in smokers.
CONCLUSIONS
CONCLUSIONS
Patients with SACP, when functional or anatomical tests are negative, have a residual risk of fatal and non-fatal cardiovascular events of 1% at 1 year of follow-up. People with incorrect lifestyles, especially smokers, have a higher risk of events. We think that in this population, a more effective intervention on lifestyles could be the key to reduce major cardiovascular events.
Identifiants
pubmed: 31432542
doi: 10.1002/clc.23250
pmc: PMC6788466
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
982-987Informations de copyright
© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.
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