Association between symptom characteristics and disease severity in patients suspected of coronary artery disease

Oliver Buchhave Pedersen; Laust Dupont Rasmussen; Louise Nissen; June Anita Ejlersen; Jesper Mortensen; Lars Christian Gormsen; Ashkan Eftekhari; Jelmer Westra; Evald Høj Christiansen; Daniel B. Mark; Morten Bøttcher; Pamela S. Douglas; Simon Winther

doi:10.1016/j.jcct.2025.01.004

Association between symptom characteristics and disease severity in patients suspected of coronary artery disease

Oliver Buchhave Pedersen^*, Laust Dupont Rasmussen, Louise Nissen, June Anita Ejlersen, Jesper Mortensen, Lars Christian Gormsen, Ashkan Eftekhari, Jelmer Westra, Evald Høj Christiansen, Daniel B. Mark, Morten Bøttcher, Pamela S. Douglas, Simon Winther

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Background: Discrepancies often exist between patient-reported symptoms and diagnostic test findings in patients with suspected obstructive coronary artery disease (CAD). Objectives: To quantify the association between patient-reported symptoms and the diagnosis of severe stenosis in patients with suspected obstructive CAD. Methods: Two large-scale cohorts of patients with new-onset symptoms suggestive of obstructive CAD were evaluated. Chest discomfort was assessed by typicality, location, type, exertional/stress factors, and relief with rest/nitroglycerine. Patients underwent non-invasive diagnostic testing (coronary computed tomographic angiography (CCTA) or functional testing), followed by test-result-driven invasive coronary angiography (ICA). Severe stenosis was defined as ≥70 % diameter stenosis on ICA. Sensitivity analyses included CCTA stenosis, functional abnormalities, and revascularization. Results: Of 14,410 patients, 2093 (14.5 %) were referred for ICA, and 765 (5.3 %) were diagnosed with severe stenosis. Patients with typical angina (n = 224) had higher odds of being diagnosed with severe stenosis on ICA (OR and 95 % CIs: 2.84 [2.40–3.34]) than those with atypical or non-anginal symptoms. In patients diagnosed with severe stenosis on ICA, those with exertional/stress factors (n = 418; OR [95 % CI]: 2.50 [2.16–2.90]) and relief with rest/nitroglycerine (n = 318, 2.28; [1.96–2.65]) had higher odds compared to those without. Patients reporting pressure or burning pain had higher odds of severe stenosis. Associations were consistent across sex and age groups, and sensitivity references. Conclusions: Exertional/stress-related chest discomfort and relief with rest/nitroglycerine increased the odds of severe stenosis in patients with suspected CAD undergoing test-result-driven ICA, while location and type of chest pain were less associated, with no differences across sex or age groups.

Original language	English
Journal	Journal of Cardiovascular Computed Tomography
ISSN	1934-5925
DOIs	https://doi.org/10.1016/j.jcct.2025.01.004
Publication status	Accepted/In press - 2025

Keywords

Coronary artery disease
Symptom characteristics
Typical angina pectoris

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10.1016/j.jcct.2025.01.004

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Pedersen, O. B., Rasmussen, L. D., Nissen, L., Ejlersen, J. A., Mortensen, J., Gormsen, L. C., Eftekhari, A., Westra, J., Christiansen, E. H., Mark, D. B., Bøttcher, M., Douglas, P. S., & Winther, S. (Accepted/In press). Association between symptom characteristics and disease severity in patients suspected of coronary artery disease. Journal of Cardiovascular Computed Tomography. https://doi.org/10.1016/j.jcct.2025.01.004

@article{788afe40dc45495a8c3ab4e495878237,

title = "Association between symptom characteristics and disease severity in patients suspected of coronary artery disease",

abstract = "Background: Discrepancies often exist between patient-reported symptoms and diagnostic test findings in patients with suspected obstructive coronary artery disease (CAD). Objectives: To quantify the association between patient-reported symptoms and the diagnosis of severe stenosis in patients with suspected obstructive CAD. Methods: Two large-scale cohorts of patients with new-onset symptoms suggestive of obstructive CAD were evaluated. Chest discomfort was assessed by typicality, location, type, exertional/stress factors, and relief with rest/nitroglycerine. Patients underwent non-invasive diagnostic testing (coronary computed tomographic angiography (CCTA) or functional testing), followed by test-result-driven invasive coronary angiography (ICA). Severe stenosis was defined as ≥70 % diameter stenosis on ICA. Sensitivity analyses included CCTA stenosis, functional abnormalities, and revascularization. Results: Of 14,410 patients, 2093 (14.5 %) were referred for ICA, and 765 (5.3 %) were diagnosed with severe stenosis. Patients with typical angina (n = 224) had higher odds of being diagnosed with severe stenosis on ICA (OR and 95 % CIs: 2.84 [2.40–3.34]) than those with atypical or non-anginal symptoms. In patients diagnosed with severe stenosis on ICA, those with exertional/stress factors (n = 418; OR [95 % CI]: 2.50 [2.16–2.90]) and relief with rest/nitroglycerine (n = 318, 2.28; [1.96–2.65]) had higher odds compared to those without. Patients reporting pressure or burning pain had higher odds of severe stenosis. Associations were consistent across sex and age groups, and sensitivity references. Conclusions: Exertional/stress-related chest discomfort and relief with rest/nitroglycerine increased the odds of severe stenosis in patients with suspected CAD undergoing test-result-driven ICA, while location and type of chest pain were less associated, with no differences across sex or age groups.",

keywords = "Coronary artery disease, Symptom characteristics, Typical angina pectoris",

author = "Pedersen, {Oliver Buchhave} and Rasmussen, {Laust Dupont} and Louise Nissen and Ejlersen, {June Anita} and Jesper Mortensen and Gormsen, {Lars Christian} and Ashkan Eftekhari and Jelmer Westra and Christiansen, {Evald H{\o}j} and Mark, {Daniel B.} and Morten B{\o}ttcher and Douglas, {Pamela S.} and Simon Winther",

note = "Publisher Copyright: {\textcopyright} 2025 Society of Cardiovascular Computed Tomography",

year = "2025",

doi = "10.1016/j.jcct.2025.01.004",

language = "English",

journal = "Journal of Cardiovascular Computed Tomography",

issn = "1934-5925",

publisher = "Elsevier Inc.",

}

Pedersen, OB, Rasmussen, LD , Nissen, L, Ejlersen, JA, Mortensen, J, Gormsen, LC, Eftekhari, A, Westra, J , Christiansen, EH, Mark, DB, Bøttcher, M, Douglas, PS & Winther, S 2025, 'Association between symptom characteristics and disease severity in patients suspected of coronary artery disease', Journal of Cardiovascular Computed Tomography. https://doi.org/10.1016/j.jcct.2025.01.004

Association between symptom characteristics and disease severity in patients suspected of coronary artery disease. / Pedersen, Oliver Buchhave; Rasmussen, Laust Dupont ; Nissen, Louise et al.
In: Journal of Cardiovascular Computed Tomography, 2025.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Association between symptom characteristics and disease severity in patients suspected of coronary artery disease

AU - Pedersen, Oliver Buchhave

AU - Rasmussen, Laust Dupont

AU - Nissen, Louise

AU - Ejlersen, June Anita

AU - Mortensen, Jesper

AU - Gormsen, Lars Christian

AU - Eftekhari, Ashkan

AU - Westra, Jelmer

AU - Christiansen, Evald Høj

AU - Mark, Daniel B.

AU - Bøttcher, Morten

AU - Douglas, Pamela S.

AU - Winther, Simon

PY - 2025

Y1 - 2025

N2 - Background: Discrepancies often exist between patient-reported symptoms and diagnostic test findings in patients with suspected obstructive coronary artery disease (CAD). Objectives: To quantify the association between patient-reported symptoms and the diagnosis of severe stenosis in patients with suspected obstructive CAD. Methods: Two large-scale cohorts of patients with new-onset symptoms suggestive of obstructive CAD were evaluated. Chest discomfort was assessed by typicality, location, type, exertional/stress factors, and relief with rest/nitroglycerine. Patients underwent non-invasive diagnostic testing (coronary computed tomographic angiography (CCTA) or functional testing), followed by test-result-driven invasive coronary angiography (ICA). Severe stenosis was defined as ≥70 % diameter stenosis on ICA. Sensitivity analyses included CCTA stenosis, functional abnormalities, and revascularization. Results: Of 14,410 patients, 2093 (14.5 %) were referred for ICA, and 765 (5.3 %) were diagnosed with severe stenosis. Patients with typical angina (n = 224) had higher odds of being diagnosed with severe stenosis on ICA (OR and 95 % CIs: 2.84 [2.40–3.34]) than those with atypical or non-anginal symptoms. In patients diagnosed with severe stenosis on ICA, those with exertional/stress factors (n = 418; OR [95 % CI]: 2.50 [2.16–2.90]) and relief with rest/nitroglycerine (n = 318, 2.28; [1.96–2.65]) had higher odds compared to those without. Patients reporting pressure or burning pain had higher odds of severe stenosis. Associations were consistent across sex and age groups, and sensitivity references. Conclusions: Exertional/stress-related chest discomfort and relief with rest/nitroglycerine increased the odds of severe stenosis in patients with suspected CAD undergoing test-result-driven ICA, while location and type of chest pain were less associated, with no differences across sex or age groups.

AB - Background: Discrepancies often exist between patient-reported symptoms and diagnostic test findings in patients with suspected obstructive coronary artery disease (CAD). Objectives: To quantify the association between patient-reported symptoms and the diagnosis of severe stenosis in patients with suspected obstructive CAD. Methods: Two large-scale cohorts of patients with new-onset symptoms suggestive of obstructive CAD were evaluated. Chest discomfort was assessed by typicality, location, type, exertional/stress factors, and relief with rest/nitroglycerine. Patients underwent non-invasive diagnostic testing (coronary computed tomographic angiography (CCTA) or functional testing), followed by test-result-driven invasive coronary angiography (ICA). Severe stenosis was defined as ≥70 % diameter stenosis on ICA. Sensitivity analyses included CCTA stenosis, functional abnormalities, and revascularization. Results: Of 14,410 patients, 2093 (14.5 %) were referred for ICA, and 765 (5.3 %) were diagnosed with severe stenosis. Patients with typical angina (n = 224) had higher odds of being diagnosed with severe stenosis on ICA (OR and 95 % CIs: 2.84 [2.40–3.34]) than those with atypical or non-anginal symptoms. In patients diagnosed with severe stenosis on ICA, those with exertional/stress factors (n = 418; OR [95 % CI]: 2.50 [2.16–2.90]) and relief with rest/nitroglycerine (n = 318, 2.28; [1.96–2.65]) had higher odds compared to those without. Patients reporting pressure or burning pain had higher odds of severe stenosis. Associations were consistent across sex and age groups, and sensitivity references. Conclusions: Exertional/stress-related chest discomfort and relief with rest/nitroglycerine increased the odds of severe stenosis in patients with suspected CAD undergoing test-result-driven ICA, while location and type of chest pain were less associated, with no differences across sex or age groups.

KW - Coronary artery disease

KW - Symptom characteristics

KW - Typical angina pectoris

UR - http://www.scopus.com/inward/record.url?scp=85215869025&partnerID=8YFLogxK

U2 - 10.1016/j.jcct.2025.01.004

DO - 10.1016/j.jcct.2025.01.004

M3 - Journal article

AN - SCOPUS:85215869025

SN - 1934-5925

JO - Journal of Cardiovascular Computed Tomography

JF - Journal of Cardiovascular Computed Tomography

ER -

Association between symptom characteristics and disease severity in patients suspected of coronary artery disease

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Keywords

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