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- Title
Brain natriuretic peptide testing for angina in a rapid-access chest pain clinic.
- Authors
S.B. Connolly; T. Collier; R. Khugputh; D. Tataree; K. Kyereme; S. Merritt; A.D. Struthers; K.F. Fox
- Abstract
Background: Patients complaining of chest pain are frequently referred to secondary care, although the majority have pain of non-cardiac origin. Aim: To investigate whether B-type natriuretic peptide (BNP) levels are predictive of a diagnosis of non-cardiac pain. Design: Cross-sectional study. Methods: Consecutive patients (n = 296) presenting to a rapid-access chest pain clinic (RACPC) received the usual clinical assessment plus near-patient BNP testing, with the assessor blinded to the result. After clinical assessment (including exercise stress testing if clinically indicated), pain was diagnosed likely/definitely cardiac or non-cardiac. Results: Median BNP was higher in those diagnosed with likely/definite cardiac chest pain (26.5 vs. 8 pg/ml) (p < 0.0001, Wilcoxon rank sum test). The odds ratio for cardiac pain in those with BNP <20 pg/ml was 0.25 (95%CI 0.14–0.47) (p < 0.0005); adjusting for age and sex reduced this to 0.41 (95%CI 0.20–0.83) (p = 0.01). The area under the curve (AUC) for the model including BNP, age and sex was 0.70. With BNP as a continuous variable, the AUC for the same model was 0.72. Discussion: In typical patients presenting to a RACPC, those with a BNP 20 pg/ml were significantly less likely to be diagnosed with cardiac pain. Near-patient BNP testing may have a role as a rule out test for angina in patients presenting to a RACPC.
- Subjects
CHEST disease diagnosis; PHYSIOLOGICAL research; PHYSIOLOGICAL stress testing; CHEST pain
- Publication
QJM: An International Journal of Medicine, 2007, Vol 100, Issue 12, p779
- ISSN
1460-2725
- Publication type
Article
- DOI
10.1093/qjmed/hcm098