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Coronary artery disease prediction in women and men using chest pain characteristics and risk factors: an observational study in outpatient clinics

OBJECTIVES: To assess the diagnostic value of non-acute chest pain characteristics for coronary artery disease in women and men referred to outpatient cardiology clinics. DESIGN AND SETTING: This is an observational study performed at outpatient cardiology centres of the Netherlands. PARTICIPANTS: T...

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Autores principales: Groepenhoff, Floor, Eikendal, Anouk L M, Onland-Moret, N Charlotte, Bots, Sophie Heleen, Menken, Roxana, Tulevski, Igor I, Somsen, Aernout G, Hofstra, Leonard, den Ruijter, Hester M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204862/
https://www.ncbi.nlm.nih.gov/pubmed/32341045
http://dx.doi.org/10.1136/bmjopen-2019-035928
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author Groepenhoff, Floor
Eikendal, Anouk L M
Onland-Moret, N Charlotte
Bots, Sophie Heleen
Menken, Roxana
Tulevski, Igor I
Somsen, Aernout G
Hofstra, Leonard
den Ruijter, Hester M
author_facet Groepenhoff, Floor
Eikendal, Anouk L M
Onland-Moret, N Charlotte
Bots, Sophie Heleen
Menken, Roxana
Tulevski, Igor I
Somsen, Aernout G
Hofstra, Leonard
den Ruijter, Hester M
author_sort Groepenhoff, Floor
collection PubMed
description OBJECTIVES: To assess the diagnostic value of non-acute chest pain characteristics for coronary artery disease in women and men referred to outpatient cardiology clinics. DESIGN AND SETTING: This is an observational study performed at outpatient cardiology centres of the Netherlands. PARTICIPANTS: The study population consisted of 1028 patients with non-acute chest pain (505 women). ANALYSIS AND RESULTS: Twenty-four women (5%) and 75 men (15%) were diagnosed with coronary artery disease by invasive coronary angiography or CT angiography during regular care follow-up. Elastic net regression was performed to assess which chest pain characteristics and risk factors were of diagnostic value. The overall model selected age, provocation by temperature or stress, relief at rest and functional class as determinants and was accurate in both sexes (area under the curve (AUC) of 0.76 (95% CI 0.68 to 0.85) in women and 0.83 (95% CI 0.78 to 0.88) in men). Both sex-specific models selected age, pressuring nature, radiation, duration, frequency, progress, provocation and relief at rest as determinants. The female model additionally selected dyspnoea, body mass index, hypertension and smoking while the male model additionally selected functional class and diabetes. The sex-specific models performed better than the overall model, but more so in women (AUC: 0.89, 95% CI 0.81 to 0.96) than in men (AUC: 0.84, 95% CI 0.73 to 0.90). CONCLUSIONS: In both sexes, the diagnostic value of non-acute chest pain characteristics and risk factors for coronary artery disease was high. Provocation, relief at rest and functional class of chest pain were the most powerful diagnostic predictors in both women and men. When stratified by sex the performance of the model improved, mostly in women.
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spelling pubmed-72048622020-05-12 Coronary artery disease prediction in women and men using chest pain characteristics and risk factors: an observational study in outpatient clinics Groepenhoff, Floor Eikendal, Anouk L M Onland-Moret, N Charlotte Bots, Sophie Heleen Menken, Roxana Tulevski, Igor I Somsen, Aernout G Hofstra, Leonard den Ruijter, Hester M BMJ Open Cardiovascular Medicine OBJECTIVES: To assess the diagnostic value of non-acute chest pain characteristics for coronary artery disease in women and men referred to outpatient cardiology clinics. DESIGN AND SETTING: This is an observational study performed at outpatient cardiology centres of the Netherlands. PARTICIPANTS: The study population consisted of 1028 patients with non-acute chest pain (505 women). ANALYSIS AND RESULTS: Twenty-four women (5%) and 75 men (15%) were diagnosed with coronary artery disease by invasive coronary angiography or CT angiography during regular care follow-up. Elastic net regression was performed to assess which chest pain characteristics and risk factors were of diagnostic value. The overall model selected age, provocation by temperature or stress, relief at rest and functional class as determinants and was accurate in both sexes (area under the curve (AUC) of 0.76 (95% CI 0.68 to 0.85) in women and 0.83 (95% CI 0.78 to 0.88) in men). Both sex-specific models selected age, pressuring nature, radiation, duration, frequency, progress, provocation and relief at rest as determinants. The female model additionally selected dyspnoea, body mass index, hypertension and smoking while the male model additionally selected functional class and diabetes. The sex-specific models performed better than the overall model, but more so in women (AUC: 0.89, 95% CI 0.81 to 0.96) than in men (AUC: 0.84, 95% CI 0.73 to 0.90). CONCLUSIONS: In both sexes, the diagnostic value of non-acute chest pain characteristics and risk factors for coronary artery disease was high. Provocation, relief at rest and functional class of chest pain were the most powerful diagnostic predictors in both women and men. When stratified by sex the performance of the model improved, mostly in women. BMJ Publishing Group 2020-04-26 /pmc/articles/PMC7204862/ /pubmed/32341045 http://dx.doi.org/10.1136/bmjopen-2019-035928 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Cardiovascular Medicine
Groepenhoff, Floor
Eikendal, Anouk L M
Onland-Moret, N Charlotte
Bots, Sophie Heleen
Menken, Roxana
Tulevski, Igor I
Somsen, Aernout G
Hofstra, Leonard
den Ruijter, Hester M
Coronary artery disease prediction in women and men using chest pain characteristics and risk factors: an observational study in outpatient clinics
title Coronary artery disease prediction in women and men using chest pain characteristics and risk factors: an observational study in outpatient clinics
title_full Coronary artery disease prediction in women and men using chest pain characteristics and risk factors: an observational study in outpatient clinics
title_fullStr Coronary artery disease prediction in women and men using chest pain characteristics and risk factors: an observational study in outpatient clinics
title_full_unstemmed Coronary artery disease prediction in women and men using chest pain characteristics and risk factors: an observational study in outpatient clinics
title_short Coronary artery disease prediction in women and men using chest pain characteristics and risk factors: an observational study in outpatient clinics
title_sort coronary artery disease prediction in women and men using chest pain characteristics and risk factors: an observational study in outpatient clinics
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204862/
https://www.ncbi.nlm.nih.gov/pubmed/32341045
http://dx.doi.org/10.1136/bmjopen-2019-035928
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