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Background: We have previously derived a chest pain score by comparing those with and without coronary artery disease on angiography, which was subsequently validated in patients attending coronary angiography., Aim: To test the predictive validity of the score prospectively in a more varied out-patient population, and to determine whether it had predictive validity in addition to exercise testing., Design: Prospective clinical study., Methods: The score was applied to 405 out-patients with chest pain who subsequently underwent coronary angiography. Framingham risk analysis and exercise testing were performed in 155., Results: The score had a sensitivity of 91.4% and specificity of 28% for coronary artery disease, which was found in 31.8%, 51%, 63%, and 82% of those with scores of 0, 1, 2, and 3, respectively. Gender (p < 0.001), age (p < 0.001), and chest pain score (p = 0.009) independently predicted coronary artery disease on multivariate Poisson regression analysis. The chest pain score had additive predictive value with Framingham risk analysis and Duke's score., Discussion: This simple chest pain score can predict coronary anatomy with similar sensitivity to exercise testing, and can be used in conjunction with exercise testing and other measures. Further validation of the chest pain score in the primary care setting will be useful.

'Typical' or 'atypical' are universally used descriptions of chest pain, but they are limited by subjectivity. This study tested the ability of a semi-objective chest pain score to predict the likelihood of coronary disease. A chest pain questionnaire was given to 250 patients with stable chest pain attending coronary angiography. The answers to three questions were defined as 'typical' or 'atypical' and summed to give a 'typical' score between 0 and 3. Logit analysis was performed based on an age cut-off of 55 years and 'typical' score. There were 96 (38%) patients with normal coronary arteries and 154 (62%) with coronary disease. In patients aged under 55 years, the likelihood of coronary disease by 'typical' score was 11% (score 0), 30% (score 1), 40% (score 2), 53% (score 3). Similar figures for age 55 years were 39% (score 0), 45% (score 1), 77% (score 2), and 85% (score 3). There is a direct relationship between 'typical' chest pain score and the likelihood of coronary artery disease. This scoring system may be useful in the clinical characterization of patients for research, for guiding referral to a cardiologist or for aiding the decision to perform coronary angiography.

Serum or plasma sialic acid and C-reactive protein have recently been shown to be cardiovascular risk factors. Our aim was to determine whether plasma sialic acid or C-reactive protein concentration correlate with atheromatous load on coronary angiography. Plasma sialic acid concentration and plasma C-reactive protein concentration were determined in 128 consecutive patients attending day case coronary angiography. Patients were excluded for previous coronary angioplasty, coronary artery bypass grafting, recent myocardial infarction, acute or chronic inflammatory disease and proximal occlusions precluding analysis of distal coronary anatomy. Total cholesterol, triglyceride, HDL cholesterol and glucose concentrations were assayed on fasting samples of venous blood. Angiograms were graded according to a semisubjective scoring system. There was no significant correlation between plasma sialic acid (r = 0.19, P = 0.07), or C-reactive protein concentration (r = 0.17, P = 0.13) and atheromatous load. There was no significant correlation between sialic acid (P = 0.13), or C-reactive protein concentration (P = 0.32) and the number of diseased coronary vessels. The difference in plasma sialic acid concentration between those with normal coronary angiograms and those with coronary artery disease did not reach significance (P = 0.08). Plasma sialic acid concentration correlated with C-reactive protein (r = 0.58, P = 0.0001), serum triglyceride (r = 0.32, P = 0.002), and blood cholesterol concentration (r = 0.22, P = 0.04). Plasma sialic acid concentration does not correlate with atheromatous load on coronary angiography in patients with stable angina.