Clinical features

• retrosternal chest pain
• pain brought on by exertion
• pain relieved in <10 minutes by rest or glyceryl trinitrate

Men: probability of ≥50% coronary artery stenosis in at least one major artery

Age  b	30 to 39	40 to 49	50 to 59	60 to 69
Asymptomatic (0 symptoms)	2%	6%	10%	12%
Non-anginal chest pain (1 symptom)	5%	14%	22%	28%
Atypical angina (2 symptoms)	22%	46%	59%	67%
Typical angina (All 3 symptoms)	70%	87%	92%	94%

Women: probability of ≥50% coronary artery stenosis in at least one major artery

Age  b	30 to 39	40 to 49	50 to 59	60 to 69
Asymptomatic (0 symptoms)	0.3%	1%	3%	8%
Non-anginal chest pain (1 symptom)	1%	3%	8%	19%
Atypical angina (2 symptoms)	4%	13%	32%	54%
Typical angina (All 3 symptoms)	26%	55%	79%	91%

Why?

Increasing age increases the risk of having unstable angina or a myocardial infarction

Patient	Target Disorder and Reference Standard	Diagnostic Test	LR+ (95% CI)	Post-test Probability
central or left-sided chest pain (pre-test probability: 41%) a	MI or unstable angina (ECG, cardiac enzymes, stress tests)	aged > 80	3.5 (1.9 to 6.4)	71%
		aged 70 to 79	2.2 (1.4 to 3.4)	61%
		aged 60 to 69	1.8 (1.3 to 2.4)	56%
		aged 50 to 59	1.1 (0.83 to 1.5)	44%
		aged 40 to 49	0.50 (0.34 to 0.72)	26%
		aged 30 to 39	0.12 (0.047 to 0.28)	8%
		aged 25 to 29	0.10 (0.024 to 0.42)	7%

Men who have chest pain are more likely to have an MI or unstable angina

Patient	Target Disorder and Reference Standard	Diagnostic Test	LR+ (95% CI)	Post-test Probability	LR- (95% CI)	Post-test Probability
central or left-sided chest pain a (pre-test probability: 41%)	Mi or unstable angina (ECG, cardiac enzymes, stress tests)	male	1.3 (1.1 to 1.5)	48%	0.77 (0.65 to 0.91)	35%