Coronary artery features in the cases of atypical chest pain with a troponin-negative result

Thunnawat Wattanaseth; Veerapun Suvannamai; Nuttakul Lungkorn; Peerapong Prabhakornritta; Chatdao Jangwangkorn; Phawit Norchai; Mart Maiprasert

doi:10.46475/asean-jr.v26i2.910

Authors

Thunnawat Wattanaseth, M.D., Ph.D. Department of Anti-Aging and Regenerative Medicine, College of Integrative Medicine (CIM), Dhurakij Pundit University, Bangkok, Thailand. https://orcid.org/0000-0002-1787-5781
Veerapun Suvannamai, M.D., FRCNST. Department of Anti-Aging and Regenerative Medicine, College of Integrative Medicine (CIM), Dhurakij Pundit University, Bangkok, Thailand. https://orcid.org/0009-0001-8635-3653
Nuttakul Lungkorn, M.D. Department of Anti-Aging and Regenerative Medicine, College of Integrative Medicine (CIM), Dhurakij Pundit University, Bangkok, Thailand. https://orcid.org/0009-0003-2285-0698
Peerapong Prabhakornritta, M.D., M.Sc. Department of Anti-Aging and Regenerative Medicine, College of Integrative Medicine (CIM), Dhurakij Pundit University, Bangkok, Thailand. https://orcid.org/0000-0002-6267-4567
Chatdao Jangwangkorn, M.D., M.Sc., B.Sc. Department of Anti-Aging and Regenerative Medicine, College of Integrative Medicine (CIM), Dhurakij Pundit University, Bangkok, Thailand. https://orcid.org/0009-0001-2901-4268
Phawit Norchai, M.D., M.Sc., Ph.D. Department of Anti-Aging and Regenerative Medicine, College of Integrative Medicine (CIM), Dhurakij Pundit University, Bangkok, Thailand. https://orcid.org/0000-0001-9154-6524
Mart Maiprasert, M.D., ABAARM. Department of Anti-Aging and Regenerative Medicine, College of Integrative Medicine (CIM), Dhurakij Pundit University, Bangkok, Thailand. https://orcid.org/0000-0001-9320-5635

DOI:

https://doi.org/10.46475/asean-jr.v26i2.910

Keywords:

Atypical chest pain, Troponin-negative, Framingham risk score, Obstructive coronary artery disease, High-risk plaque features

Abstract

Objective: To analyze features of coronary artery disease (CAD) on CT angiography (CTA) in the cases of atypical chest pain with troponin-negative (TNEG), by the retrospective study of 4.5-year data documents, Jan 2020 to Apr 2024.

Materials and Methods: There were 270 eligible cases of atypical chest pain with troponin-negative (TNEG), determined by data documents via Picture Archiving and Communication System (PACS) and Hospital Information System (HIS), Jan 2020 to Apr 2024. The known cases of CAD, status post coronary stent (s), and surgical bypass graft (s) were excluded. The eligible cases were analyzed cardiovascular risk factors, determined by Framingham Risk Score (FRS), the degrees of coronary artery stenosis, the degrees of coronary artery calcification, and high-risk plaque features (HRPF) on CT angiography (CTA), using the standardized CAD reporting and data system (CAD-RADS) version 2.0 (2022) of American College of Cardiology (ACC)/American Heart Association (AHA). Logistic regression, t-test, Chi-square, Spearman’s correlation, and Adjusted Odd ratio were used analyzed the significance of variables.

Results: The mean age [range] of 270 eligible cases was 57 [24-90] years. Evidence of coronary artery disease (CAD-RADS 1 to 5, from 1% to 100% coronary stenosis) and obstructive coronary artery (>50% stenosis) were present in 118 cases (42.7%) and 66 cases (24.4%), respectively. The HRPF was found in 48 cases (17.8%), mean age [range]: 61 [42-77] years. The age’s group of 50 to 99 years-old had significant associated with CAD and obstructive CAD. There were 190 cases (70%) had intermediate to high cardiovascular risk (FRS). The intermediate FRS was associated with positive CAD at 6.34 times to the low FRS [Multivariate adjusted OR = 6.34 (95% CI (3.16-12.73)]. The high FRS was associated with positive CAD at 10.3 times to the low FRS [Multivariate adjusted OR = 10.3 (95% CI (4.40-24.20)]. Moreover, there were the strong correlation between CAD-RADS 0 (0% stenosis) and the coronary artery calcium score (CACS) 0-100 [0 and P1], and moderate to strong correlation between the obstructive coronary artery (CAD-RADS 3-5) and CACS > 301 [P3 and P4].

Conclusion: Atypical chest pain with troponin-negative (TNEG) on the age > 50-year-old with intermediate to high cardiovascular risk (FRS) had significant obstructive coronary disease (> 50% stenosis, CAD-RADS 3 to 5) and presence of high-risk plaque features (HRPF), determined by CT angiography.

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References

Task Force Members, Montalescot G, Sechtem U et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013; 34:2949-3003. doi: 10.1093/eurheartj/eht296. Epub 2013 Aug 30. Erratum in: Eur Heart J. 2014 Sep 1;35(33):2260-1. PMID: 23996286.

Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267-315. doi: 10.1093/eurheartj/ehv320. Epub 2015 Aug 29. PMID: 26320110.

Sebastien Hascoët, Vanina Bongard, Valerie Chabbert, Marie-Agnes Marachet, Herve Rousseau, Sandrine Charpentier, Frederic Bouisset, Benjamin Honton, Olivier Lairez, Pauline Marchal, Matthieu Berry, Didier Carrié, Michel Galinier, Meyer Elbaz. Early triage of emergency department patients with acute coronary syndrome: Contribution of 64-slice computed tomography angiography. Archives of Cardiovascular Diseases. 2012; 105;6-7:338-346. https://doi.org/10.1016/j.acvd.2012.04.001

Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2019. doi: 10.1093/eurheartj/ehz425. Erratum in: Eur Heart J. 2020 Nov 21;41(44):4242. PMID: 31504439.

Motoyama S, Kondo T, Sarai M et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol 2007; 50:319-26. doi: 10.1016/j.jacc.2007.03.044. Epub 2007 Jul 6. PMID: 17659199.

Krul MM, Bogaard K, Knol RJ, van Rossum AC, Knaapen P, Cornel JH, van der Zant FM. Coronary artery disease in patients with atypical chest pain with and without diabetes mellitus assessed with coronary CT angiography. BMJ Open Diabetes Res Care. 2014 Apr 23;2(1): e000004. doi: 10.1136/bmjdrc-2013-000004. PMID: 25452855; PMCID: PMC4212558.

Shaw LJ, Blankstein R, Bax JJ, Ferencik M, Bittencourt MS, Min JK, et al. Society of Cardiovascular Computed Tomography / North American Society of Cardiovascular Imaging - Expert Consensus Document on Coronary CT Imaging of Atherosclerotic Plaque. J Cardiovasc Comput Tomogr. 2021;15(2):93-109. doi: 10.1016/j.jcct.2020.11.002. Epub 2020 Nov 9. PMID: 33303383.

Cury RC, Leipsic J, Abbara S, Achenbach S, Berman D, Bittencourt M, et al. CAD-RADS 2.0 - 2022 Coronary Artery Disease - Reporting and Data System an Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR) and the North America Society of Cardiovascular Imaging (NASCI). Radiol Cardiothorac Imaging. 2022;4(5): e220183. doi: 10.1016/j.jcct.2022.07.002. Epub 2022 Jul 8. PMID: 35864070.

Haase R, Schlattmann P, Gueret P, Andreini D, Pontone G, Alkadhi H, Hausleiter J, Garcia MJ, Leschka S, Meijboom WB, Zimmermann E, Gerber B, Schoepf UJ, Shabestari AA, Nørgaard BL, Meijs MFL, Sato A, Ovrehus KA, Diederichsen ACP, Jenkins SMM, Knuuti J, Hamdan A, Halvorsen BA, Mendoza-Rodriguez V, Rochitte CE, Rixe J, Wan YL, Langer C, Bettencourt N, Martuscelli E, Ghostine S, Buechel RR, Nikolaou K, Mickley H, Yang L, Zhang Z, Chen MY, Halon DA, Rief M, Sun K, Hirt-Moch B, Niinuma H, Marcus RP, Muraglia S, Jakamy R, Chow BJ, Kaufmann PA, Tardif JC, Nomura C, Kofoed KF, Laissy JP, Arbab-Zadeh A, Kitagawa K, Laham R, Jinzaki M, Hoe J, Rybicki FJ, Scholte A, Paul N, Tan SY, Yoshioka K, Röhle R, Schuetz GM, Schueler S, Coenen MH, Wieske V, Achenbach S, Budoff MJ, Laule M, Newby DE, Dewey M; COME-CCT Consortium. Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data. BMJ. 2019 Jun 12;365: l1945. doi: 10.1136/bmj. l1945. PMID: 31189617; PMCID: PMC6561308.

AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines, Volume: 144, Issue: 22, Pages: e368-e454, DOI: (10.1161/CIR.0000000000001029)

Varnava AM, Mills PG, Davies MJ. Relationship between coronary artery remodeling and plaque vulnerability. Circulation 2002; 105:939-43. doi: 10.1161/hc0802.104327. PMID: 11864922.

Celeng C, Takx RA, Ferencik M, Maurovich-Horvat P. Non-invasive and invasive imaging of vulnerable coronary plaque. Trends Cardiovasc Med 2016; 26:538-47. doi: 10.1016/j.tcm.2016.03.005. Epub 2016 Mar 15. PMID: 27079893.

Maurovich-Horvat P, Hoffmann U, Vorpahl M, Nakano M, Virmani R, Alkadhi H. The napkin-ring sign: CT signature of high-risk coronary plaques? JACC Cardiovasc Imaging 2010; 3:440-4. doi: 10.1016/j.jcmg.2010.02.003. PMID: 20394906.

Nerlekar N, Ha FJ, Cheshire C et al. Computed Tomographic Coronary Angiography-Derived Plaque Characteristics Predict Major Adverse Cardiovascular Events: A Systematic Review and Meta-Analysis. Circ Cardiovasc Imaging 2018;11: e006973. doi: 10.1161/CIRCIMAGING.117.006973. PMID: 29305348.

Pontone G, Rossi A, Baggiano A, Andreini D, Conte E, Fusini L, Gebhard C, Rabbat MG, Guaricci A, Guglielmo M, Muscogiuri G, Mushtaq S, Al-Mallah MH, Berman DS, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Chun EJ, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Kim YJ, Lee BK, Lee SE, Maffei E, Marques H, Samady H, Shin S, Sung JM, van Rosendael A, Virmani R, Bax JJ, Leipsic JA, Lin FY, Min JK, Narula J, Shaw LJ, Chang HJ. Progression of non-obstructive coronary plaque: a practical CCTA-based risk score from the PARADIGM registry. Eur Radiol. 2024 Apr;34(4):2665-2676. doi: 10.1007/s00330-023-09880-x. Epub 2023 Sep 26. PMID: 37750979.