title: Diagnostic and prognostic value of a careful symptom evaluation and high sensitive troponin in patients with suspected stable angina pectoris without prior cardiovascular disease.
abstract: Typical angina pectoris (AP) and high-sensitive troponin I (hs-TnI) are independently associated with coronary artery disease (CAD) and future cardiovascular events (CVE). This study aimed to assess the individual and combined diagnostic and prognostic impact of symptoms and hs-TnI in stable chest pain patients without prior cardiovascular disease.
  
  
  
  During a one-year period, 487 patients with suspected stable AP underwent invasive or CT-coronary angiography (significant stenosis ≥50%). At study inclusion, a careful symptom evaluation was obtained, and patients were classified as having typical AP, atypical AP, or non-cardiac chest pain. Hs-TnI was measured in all patients and divided into tertiles for analysis. Follow-up was a median of 4.9 years with cardiovascular death, non-fatal myocardial infarction, unstable AP, ischemic stroke, coronary-artery-bypass-grafting, percutaneous coronary intervention, and peripheral vascular surgery as combined endpoint.
  
  
  
  Hs-TnI was detected in 486 patients (99.8%). By multivariate regression analysis, typical AP and hs-TnI elevation were associated with increased risk of having significant CAD (typical AP, OR: 3.46; 95% CI: 2.07-5.79; p < 0.0001, hs-TnI, OR: 1.50; 95% CI: 1.12-2.01; p = 0.007) and experiencing future CVE (typical AP, HR: 2.64; 95% CI: 1.74-3.99; p = 0.001, hs-TnI, HR: 1.26; 95% CI: 1.06-1.49; p = 0.008). Patients in the lowest hs-TnI tertile, without typical AP (n = 107) had a 1.9% absolute risk of significant CAD and a 3.7% absolute risk of long-term CVE.
  
  
  
  In clinical stable patients without known cardiovascular disease, a thorough chest-pain history in combination with hs-TnI testing can identify a significant low-risk group. The prognostic need for coronary angiography in these patients seems limited.
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense C, Denmark.
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Madsen
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense C, Denmark.
authors.forename: Axel C P
authors.initials: ACP
authors.lastname: Diederichsen
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense C, Denmark.
authors.forename: Susanne E
authors.initials: SE
authors.lastname: Hosbond
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, Odense C, Denmark.
authors.forename: Oke
authors.initials: O
authors.lastname: Gerke
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense C, Denmark. Electronic address: Hans.Mickley@rsyd.dk.
authors.forename: Hans
authors.initials: H
authors.lastname: Mickley
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D000789:Angina, Unstable / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D002561:Cerebrovascular Disorders / Q000209:etiology; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D023921:Coronary Stenosis / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D009204:Myocardial Revascularization; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D019210:Troponin I / Q000097:blood*; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D019210:Troponin I
keywords: Cardiovascular risk; Coronary artery disease; High-sensitive troponin I; Stable angina pectoris