title: Prognostic value of reported chest pain for cardiovascular risk stratification in primary care.
abstract: BACKGROUND
  The prognostic significance of chest pain is well established in patients with coronary artery disease, but still ill defined in primary prevention. Therefore, the aim of our analysis was to assess the prognostic value of different forms of chest pain in a large cohort of primary care subjects under the conditions of contemporary modalities of care in primary prevention, including measurement of serum levels of the biomarker NT-pro-BNP.
  
  
  METHODS
  We carried out a post-hoc analysis of the prospective DETECT cohort study.
  
  
  METHODS
  In a total of 5570 unselected subjects, free of coronary artery disease, within the 55,518 participants of the cross-sectional DETECT study, we assessed chest pain history by a comprehensive questionnaire and measured serum NT-pro-BNP levels. Three types of chest pain, which were any chest pain, exertional chest pain and classical angina, were defined. Major adverse cardiovascular events (MACEs = cardiovascular death, myocardial infarction, coronary revascularization procedures) were assessed during a 5-year follow-up period.
  
  
  RESULTS
  During follow-up, 109 subjects experienced a MACE. All types of reported chest pain were associated with an approximately three-fold increased risk for the occurrence of incident MACEs, even after adjusting for cardiovascular risk factors. Any form of reported chest pain had a similar predictive value for MACEs as a one-time measurement of NT-pro-BNP. However, adding a single measurement of NT-pro-BNP and the information on chest pain resulted in reclassification of approximately 40% of subjects, when compared with risk prediction based on established cardiovascular risk factors.
  
  
  CONCLUSIONS
  In primary prevention, self-reported chest pain and a single measurement of NT-pro-BNP substantially improve cardiovascular risk prediction and allow for risk reclassification of approximately 40% of the subjects compared with assessing classical cardiovascular risk factors alone.
authors: Department of Internal Medicine III, Cardiology, Goethe-University Frankfurt, Germany.
authors: David M
authors: DM
authors: Leistner
authors: Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany.
authors: Jens
authors: J
authors: Klotsche
authors: Department of Internal Medicine III, Cardiology, Goethe-University Frankfurt, Germany.
authors: Sylvia
authors: S
authors: Palm
authors: Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany.
authors: Lars
authors: L
authors: Pieper
authors: Max Planck Institute of Psychiatry, Munich, Germany.
authors: Günter K
authors: GK
authors: Stalla
authors: Department of Medicine I, University of Schleswig-Holstein, Campus Lübeck, Germany.
authors: Hendrik
authors: H
authors: Lehnert
authors: Cardiology Practice and Hospital, Munich, Germany.
authors: Sigmund
authors: S
authors: Silber
authors: Synlab Center of Laboratory Diagnostics, Heidelberg, Germany.
authors: Winfried
authors: W
authors: März
authors: Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany.
authors: Hans-Ulrich
authors: HU
authors: Wittchen
authors: Department of Internal Medicine III, Cardiology, Goethe-University Frankfurt, Germany Zeiher@em.uni-frankfurt.de.
authors: Andreas M
authors: AM
authors: Zeiher
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis*; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011320:Primary Health Care; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain