Patients with Undiagnosed Chest Pain Still at Cardiovascular Risk

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Most U.K. patients presenting with chest pain for the first time are not given a diagnosis within 6 months, according to a study in The BMJ. These patients are at increased cardiovascular risk in subsequent years.

Using national registries, researchers examined records of nearly 175,000 adults presenting to primary care with first-time chest pain. Nearly 75% had unattributed chest pain; of these, roughly 95% had no cardiovascular diagnosis at 6 months.

Compared with patients whose chest pain was found to have noncoronary causes, the unattributed group had higher rates of myocardial infarction (25 vs. 16 events per 10,000 person-years) and cardiovascular disease (159 vs. 101 per 10,000 person-years) through 5.5 years' follow-up.

An editorialist writes: "We might recognize that pain with no attributed cause may be an early signal, or simply a proxy for an increased risk of future myocardial infarction."