Clinical features

Why?

Pressure makes coronary artery disease more likely, but sharp or stabbing pain make it less likely

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)	pressure	1.7 (1.4 to 2.0)	54%	0.67 (0.57 to 0.78)	32%
		sharp or stabbing pain	0.41 (0.29 to 0.63)	22%	1.3 (1.2 to 1.5)	48%

A pleuritic chest pain makes unstable angina or a myocardial infarction unlikely

Patient	Target Disorder and Reference Standard	Diagnostic Test	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)	pleuritic pain	0.0 (0.0 to 0.12)	0%
		partly pleuritic pain	0.22 (0.13 to 0.39)	14%
		pain not pleuritic	1.4 (1.3 to 1.6)	50%

Positional chest pain makes unstable angina or a myocardial infarction less likely

Patient	Target Disorder and Reference Standard	Diagnostic Test	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)	positional pain	0.13 (0.030 to 0.54)	8%
		pain partly positional	0.31 (0.20 to 0.48)	18%
		pain not positional	1.4 (1.3 to 1.5)	49%

Note:

• Aching or burning pain is not helpful at diagnosing or excluding myocardial infarction or unstable angina ^a
• None of the following are helpful in diagnosing aortic dissection or its location: ^c
  • history of excitement triggering the pain
  • position of pain