Clinical Analysis Of Non-Coronary Artery Disease Patients With Chest Pain

Objective To analyze the characteristics and cause of misdiagnosis of chest pain in non-coronary artery disease patients in order to improve the accuracy of chest pain diagnosis.Methods A total of276suspected CAD patients were admitted and received coronary angiography (CAG), computerized tomography of coronary artery(CTCA), single photon emission computed tomography myocardial perfusion imaging(SPECT-MPI) examination.It turned out that141patients without CAD, and122patients with CAD.We compared those two groups of patients by the relevant information through their medical records, questionnairs and telephone follow—up for the risk factors, chest pain characters and mental status.Results Compared with CAD patients, non-CAD patients had the younger age, more female gender and with the longer history of misdiagnosis, lower proportion of typical chest pain and ECG ST-T segment changes, and fewer echocardiographic left ventricular diastolic function and wall motion dysfunction (P<0.001-0.05respectively.), the difference was statistically significant. Risk factors of hypertension, diabetes, hyperlipidemia, chest pain incentives、location、accompanied by radiating pain, taking nitroglycerin response rates, and state of mind, which was no significant difference (p>0.05).There were63.1%of non-CAD cases were misdiagnosed by ECG and echocardiography,and17.0%were misdiagnosed by the character of chest pain without further necessary examinations.58.7%of non-CAD patients were treated as CAD, the highest medical costs had24million or so before a definite diagnosis.Their medical cost was about4.74times higher than CAD treatment.48.2%of non-CAD cases were misdiagnosed by physicians and36.9%were misdiagnosed for their own reasons. and85.1%of patients misdiagnosed more than one year. The complex etiology of non-coronary heart disease patients with chest pain. The major cause of non-CAD chest pain including the nerve,mental, spiritual factors(53.7%),gastrointestinal diseases(18.7%),and cervical disease(11.4%).After excluding CAD,81.3%of patients had improved symptoms and91.1%of patients factors(53.7%),gastrointestinal diseases(18.7%),and cervical disease(11.4%).After excluding CAD,81.3%of patients had improved symptoms and91.1%of patients stopped taking CAD medication,the mental status improved significantly.Conclusions CAG or CTCA are necessary examinations for suspected patients who could not be accurately diagnosed.The medication for CAD should not be used until the diagnosis is clear.Both physician and patient must be alert for thediagnosis. With a higher rate of misdiagnosis for female, clinical diagnosis should be more cautious.