Coronary artery features in the cases of atypical chest pain with a troponin-negative result

Objective: To analyze features of coronary artery disease (CAD) on CT angiography (CTA) in the cases of atypical chest pain with troponin-negative (TNEG), by the retrospective study of 4.5-year data documents, Jan 2020 to Apr 2024. Materials and Methods: There were 270 eligible cases of atypical chest pain with troponin-negative (TNEG), determined by data documents via Picture Archiving and Communication System (PACS) and Hospital Information System (HIS), Jan 2020 to Apr 2024. The known cases of CAD, status post coronary stent (s), and surgical bypass graft (s) were excluded. The eligible cases were analyzed cardiovascular risk factors, determined by Framingham Risk Score (FRS), the degrees of coronary artery stenosis, the degrees of coronary artery calcification, and high-risk plaque features (HRPF) on CT angiography (CTA), using the standardized CAD reporting and data system (CAD-RADS) version 2.0 (2022) of American College of Cardiology (ACC)/American Heart Association (AHA). Logistic regression, t-test, Chi-square, Spearman’s correlation, and Adjusted Odd ratio were used analyzed the significance of variables. Results: The mean age [range] of 270 eligible cases was 57 [24-90] years. Evidence of coronary artery disease (CAD-RADS 1 to 5, from 1% to 100% coronary stenosis) and obstructive coronary artery (>50% stenosis) were present in 118 cases (42.7%) and 66 cases (24.4%), respectively. The HRPF was found in 48 cases (17.8%), mean age [range]: 61 [42-77] years. The age’s group of 50 to 99 years-old had significant associated with CAD and obstructive CAD. There were 190 cases (70%) had intermediate to high cardiovascular risk (FRS). The intermediate FRS was associated with positive CAD at 6.34 times to the low FRS [Multivariate adjusted OR = 6.34 (95% CI (3.16-12.73)]. The high FRS was associated with positive CAD at 10.3 times to the low FRS [Multivariate adjusted OR = 10.3 (95% CI (4.40-24.20)]. Moreover, there were the strong correlation between CAD-RADS 0 (0% stenosis) and the coronary artery calcium score (CACS) 0-100 [0 and P1], and moderate to strong correlation between the obstructive coronary artery (CAD-RADS 3-5) and CACS > 301 [P3 and P4]. Conclusion: Atypical chest pain with troponin-negative (TNEG) on the age > 50-year-old with intermediate to high cardiovascular risk (FRS) had significant obstructive coronary disease (> 50% stenosis, CAD-RADS 3 to 5) and presence of high-risk plaque features (HRPF), determined by CT angiography.