Table 4.
Diagnostic accuracy of pain characteristics
| Case definition of CHD |
Studies |
Patients |
LR (95% CI) if symptom is |
|
|---|---|---|---|---|
| present present | absent | |||
|
Central chest pain |
||||
| Any CHD |
14 |
11 673 |
1.26 (1.14-1.40) |
0.69 (0.53-0.92) |
| Stable CHD |
5 |
885 |
1.36 (1.09-1.69) |
0.65 (0.38-1.10) |
| MI |
9 |
10 788 |
1.23 (1.10-1.38) |
0.71 (0.50-0.99) |
|
Left-sided chest pain |
||||
| Any CHD† |
12 |
5608 |
0.85 (0.60-1.20) |
1.06 (0.96-1.18) |
|
Right-sided chest pain |
||||
| Any CHD |
5 |
2170 |
1.06 (0.55-2.05) |
0.99 (0.86-1.14) |
| Stable CHD |
2 |
535 |
0.76 (0.51-1.14) |
1.17 (0.81-1.68) |
| MI |
3 |
1635 |
1.39 (0.58-3.34) |
0.96 (0.87-1.06) |
|
Radiation to left arm/shoulder |
||||
| Any CHD† |
12 |
16 316 |
1.30 (1.12-1.52) |
0.86 (0.78-0.95) |
|
Radiation to right arm/shoulder |
||||
| Any CHD |
9 |
2717 |
2.95 (1.42-6.12) |
0.87 (0.80-0.96) |
| Stable CHD |
3 |
627 |
1.42 (0.66-3.03) |
0.93 (0.82-1.05) |
| MI |
6 |
2090 |
4.43 (1.77-11.10) |
0.87 (0.77-0.97) |
|
Visceral pain |
||||
| Any CHD |
17 |
15 059 |
1.34 (1.07-1.67) |
0.78 (0.60-1.02) |
| Stable CHD |
5 |
885 |
1.34 (1.01-1.78) |
0.68 (0.37-1.22) |
| MI |
10 |
13194 |
1.21 (0.89-1.63) |
0.87 (0.66-1.15) |
| ACS |
2 |
980 |
2.05 (1.14-3.68) |
0.63 (0.28-1.43) |
|
Stabbing pain |
||||
| Any CHD |
11 |
12 269 |
0.86 (0.48-1.56) |
1.02 (0.94-1.10) |
| Stable CHD |
4 |
939 |
0.90 (0.41-2.00) |
1.02 (0.87-1.19) |
| MI |
6 |
11082 |
0.69 (0.34-1.40) |
1.04 (0.94-1.15) |
| ACS |
1 |
248 |
3.65 (0.45-29.94) |
0.93 (0.83-1.04) |
|
Burning pain |
||||
| Any CHD |
7 |
2582 |
1.38 (0.93-2.04) |
0.97 (0.93-1.01) |
| Stable CHD |
2 |
535 |
1.51 (0.74-3.08) |
0.96 (0.90-1.03) |
| MI |
5 |
2047 |
1.35 (0.87-2.09) |
0.97 (0.93-1.02) |
|
Frightening pain |
||||
| Any CHD† |
4 |
1608 |
1.40 (0.61-3.21) |
0.92 (0.79-1.08) |
|
Time since onset of pain >6 h |
||||
| Any CHD |
9 |
14 499 |
0.85 (0.66-1.09) |
1.09 (0.95-1.26) |
| MI |
6 |
12 212 |
0.82 (0.59-1.14) |
1.10 (0.93-1.29) |
| ACS |
3 |
2287 |
0.90 (0.62-1.30) |
1.08 (0.82-1.44) |
|
Typical angina |
||||
| Any CHD |
14 |
28 482 |
2.36 (1.47-3.79) |
0.61 (0.44-0.86) |
| Stable CHD |
13 |
19 720 |
2.35 (1.44-3.83) |
0.61 (0.43-0.87) |
| MCE |
1 |
8762 |
2.60 (0.46-14.63) |
0.58 (0.17-2.06) |
|
Atypical angina |
||||
| Any CHD |
5 |
19 524 |
0.72 (0.53-0.97) |
1.28 (1.01-1.62) |
| Stable CHD |
4 |
10 762 |
0.74 (0.53-1.05) |
1.22 (0.96-1.57) |
| MCE |
1 |
8762 |
0.64 (0.37-1.11) |
1.53 (0.87-2.67) |
|
Pain relief by nitro-glycerine |
||||
| Stable CHD |
9 |
2813 |
1.25 (1.05-1.48) |
0.77 (0.65-0.92) |
|
Pain related to effort |
||||
| Any CHD |
8 |
2975 |
1.89 (1.23-2.92) |
0.74 (0.56-0.97) |
| Stable CHD |
6 |
1302 |
2.13 (1.36-3.33) |
0.67 (0.49-0.91) |
| MI | 2 | 1673 | 1.22 (0.50-2.96) | 0.94 (0.69-1.28) |
*Abbreviations: CHD – coronary heart disease; MI – myocardial infarction; ACS – acute coronary syndrome; MCE – major cardiac event; LR – likelihood ratio; CI – confidence interval.
†Results for different case definitions of CHD not provided, since the random effects meta-analysis with covariate “case definition” did not produce stable estimates.