Use of Coronary CT Angiography to Predict Obstructive Lesions in Patients with Chest Pain without Enzyme and ST-Segment Elevation
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Baseline Characteristics of the Study Population
3.2. New Prediction Model for the Occurrence of Significant Stenosis on CCTA
3.3. Diagnostic Performance of the New Prediction Model
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | Total (n = 904) | Not Significant (n = 770) | Significant (n = 134) | p-Value |
---|---|---|---|---|
Age, years | 61.0 (54.0–70.0) | 61.0 (52.0–70.0) | 66.0 (58.0–80.0) | <0.001 |
Male | 543 (60.1) | 436 (56.6) | 107 (79.9) | <0.001 |
Vital signs 1 | ||||
SBP, mmHg | 141.0 (128.0–155.0) | 141.0 (128.0–155.0) | 142.0 (126.5–157.0) | 0.852 |
DBP, mmHg | 85.0 (76.0–94.0) | 85.0 (77.0–94.0) | 84.0 (73.5–92.5) | 0.129 |
Pulse rate | 78.0 (68.0–89.0) | 78.0 (68.0–90.0) | 76.0 (67.0–87.0) | 0.202 |
Respiratory rate | 18.0 (18.0–20.0) | 18.0 (18.0–20.0) | 18.0 (18.0–20.0) | 0.992 |
Underlying disease | ||||
Hypertension | 383 (42.4) | 313 (40.6) | 70 (52.2) | 0.012 |
Diabetes | 160 (17.7) | 122 (15.8) | 38 (28.4) | <0.001 |
Hyperlipidemia | 157 (17.4) | 136 (17.7) | 21 (15.7) | 0.575 |
Current smoking | 79 (8.7) | 63 (8.2) | 16 (11.9) | 0.155 |
Obesity | 8 (0.9) | 4 (0.5) | 4 (3.0) | 0.005 |
History of AMI | 222 (24.6) | 148 (19.2) | 74 (55.2) | <0.001 |
History of stroke | 31 (3.4) | 25 (3.2) | 6 (4.5) | 0.470 |
Family history of CAD | 25 (2.8) | 22 (2.9) | 3 (2.2) | 0.687 |
Symptoms | ||||
Typical pain 2 | 243 (26.9) | 178 (23.1) | 65 (48.5) | <0.001 |
Atypical pain 3 | 438 (48.5) | 385 (50.0) | 53 (39.6) | 0.026 |
Radiating | 199 (22.0) | 167 (21.7) | 32 (23.9) | 0.572 |
Diaphoresis | 133 (14.7) | 106 (13.8) | 27 (20.1) | 0.054 |
Laboratories | ||||
Hb, mg/dL | 13.8 (12.6–14.8) | 13.9 (12.7–14.9) | 13.7 (12.6–14.8) | 0.292 |
Platelet, ×103/µL | 231.0 (197.0–275.0) | 233.0 (199.0–278.0) | 218.0 (180.0–259.5) | 0.002 |
PT, INR | 0.99 (0.96–1.04) | 0.99 (0.96–1.04) | 1.00 (0.96–1.06) | 0.357 |
D-dimer, µg/mL | 0.29 (0.19–0.50) | 0.29 (0.19–0.49) | 0.33 (0.21–0.60) | 0.023 |
CK-MB, ng/mL | 0.95 (0.50–1.80) | 0.90 (0.40–1.70) | 1.10 (0.60–2.00) | 0.067 |
TnI, ng/mL | 0.006 (0.006–0.006) | 0.006 (0.006–0.006) | 0.006 (0.006–0.008) | 0.001 |
Creatinine, mg/dL | 0.84 (0.71–0.97) | 0.83 (0.70–0.96) | 0.91 (0.77–1.05) | <0.001 |
Variables | Multivariate Analysis | Points | ||
---|---|---|---|---|
Adjusted OR | 95% CI | p-Value | ||
Age ≥ 65 years 1 | 1.914 | 1.265–2.897 | 0.002 | 2 |
Male | 2.940 | 1.809–4.780 | <0.001 | 3 |
Typical chest pain | 2.186 | 1.446–3.304 | <0.001 | 2 |
Diabetes | 1.838 | 1.155–2.926 | 0.010 | 2 |
History of AMI | 3.442 | 2.283–5.190 | <0.001 | 3 |
Sum | 12 |
Cutoff | Sensitivity | Specificity | PLR | NLR | PPV | NPV |
---|---|---|---|---|---|---|
≥2 | 100.0 | 15.5 | 1.2 | 0.0 | 17.1 | 100.0 |
≥3 | 100.0 | 15.5 | 1.2 | 0.0 | 17.1 | 100.0 |
≥4 | 93.3 | 31.8 | 1.4 | 0.2 | 19.2 | 96.5 |
≥5 | 86.6 | 56.4 | 2.0 | 0.2 | 25.7 | 96.0 |
≥6 | 82.1 | 60.7 | 2.1 | 0.3 | 26.6 | 95.1 |
≥7 | 64.9 | 77.5 | 2.9 | 0.5 | 33.5 | 92.7 |
≥8 | 57.5 | 82.0 | 3.2 | 0.5 | 35.7 | 91.7 |
≥9 | 41.0 | 90.5 | 4.3 | 0.7 | 43.0 | 89.8 |
≥10 | 21.6 | 94.6 | 4.0 | 0.8 | 40.9 | 87.4 |
≥11 | 19.4 | 95.5 | 4.3 | 0.8 | 42.6 | 87.2 |
≥12 | 3.7 | 99.5 | 7.2 | 1.0 | 55.6 | 85.3 |
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Kim, J.-s.; Kim, Y.-J.; Shin, Y.S.; Ahn, S.; Kim, W.Y. Use of Coronary CT Angiography to Predict Obstructive Lesions in Patients with Chest Pain without Enzyme and ST-Segment Elevation. J. Clin. Med. 2021, 10, 5442. https://doi.org/10.3390/jcm10225442
Kim J-s, Kim Y-J, Shin YS, Ahn S, Kim WY. Use of Coronary CT Angiography to Predict Obstructive Lesions in Patients with Chest Pain without Enzyme and ST-Segment Elevation. Journal of Clinical Medicine. 2021; 10(22):5442. https://doi.org/10.3390/jcm10225442
Chicago/Turabian StyleKim, June-sung, Youn-Jung Kim, Yo Sep Shin, Shin Ahn, and Won Young Kim. 2021. "Use of Coronary CT Angiography to Predict Obstructive Lesions in Patients with Chest Pain without Enzyme and ST-Segment Elevation" Journal of Clinical Medicine 10, no. 22: 5442. https://doi.org/10.3390/jcm10225442