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(CAD)patients in order to improve the accuracy of chest pain diagnosis. Methods:A total of 241 suspected CAD patients were admitted and received coronary angiography(CAG),coronary CT(CTCA) and radionuclide myocardial perfusion imaging(SPECT) examination.It turned out that 106 patients without CAD,and 122 patients with CAD.We compared those two groups of patients by the relevant information through their medical records,questionnaires and telephone follow-up for the risk factors,chest pain characters and mental status.13 patients were excluded from this study. Results:Compared with CAD patients,non-CAD patients had the younger age,more female gender and with the longer history of misdiagnosis,P0.001~0.05 respectively.There were 66.0% of non-CAD cases were misdiagnosed by ECG and echocardiography,and 14.2% were misdiagnosed by the character of chest pain without further necessary examinations.53.8% of non-CAD patients were treated as CAD,their medical cost was about 4.73 times higher than CAD treatment.53.8% of non-CAD cases were misdiagnosed by physicians and 35.8% were misdiagnosed for their own reasons.The major cause of non-CAD chest pain including the nerve,mental,spiritual factors(51.1%),gastrointestinal diseases(21.5%) and cervical disease(14.8%).After excluding CAD,85.2% of patients had improved symptoms and 90.9% of patients stopped taking CAD medication,the mental status improved significantly. Conclusion: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 the diagnosis.