Symptoms Don’t Always Indicate the Severity of Coronary Artery Disease
Symptoms Don’t Always Indicate the Severity of Coronary Artery Disease
Date: June 18, 2025
Source: JACC: Cardiovascular Imaging.
Scientific Summary (Key Points):
1. Study Focus:
New research shows that coronary artery disease (CAD) symptoms are not always reliable indicators of the actual severity of atherosclerosis or stenosis.
2. Lead Author:
Dr. Jonathon Leipsic, St. Paul’s Hospital, Vancouver.
3. Study Design:
• Data from ADVANCE registry: 4,382 patients.
• Patients grouped by symptoms:
▪ 1079 asymptomatic
▪ 438 with dyspnea
▪ 277 with noncardiac chest pain
▪ 1621 with atypical chest pain
▪ 967 with typical angina
• Tools used:
▪ AI-based plaque quantification (Total Percentage Atheroma Volume – TPAV)
▪ FFR-CT to assess functional significance of stenosis.
4. Key Findings:
• No consistent correlation between symptoms and either TPAV or FFR-CT.
• Typical angina was associated with more plaque and abnormal FFR-CT.
• Atypical or noncardiac pain and dyspnea showed weak or inverse correlations.
• Even asymptomatic patients could have significant atherosclerosis.
5. Clinical Implications:
• Symptoms alone are not reliable to guide decisions in CAD.
• Reliance on symptom-based assessment may lead to missed diagnoses or under-treatment.
6. Expert Opinion – Dr. Matthew Budoff (UCLA):
• Reinforces the importance of CT angiography in early diagnosis.
• Supports the 2021 AHA/ACC chest pain guidelines recommending CT as a first-line tool.
• Emphasizes the need to assess plaque burden, not just symptoms or stenosis.
7. Clinical Role of Symptoms (Clarification):
Despite the weak correlation found between symptoms and plaque burden or FFR-CT, symptoms remain a key component of clinical assessment. According to the AHA/ACC & ESC Chest Pain Guidelines, evaluating symptom type and severity—particularly typical angina—is crucial for risk stratification, determining urgency of testing, and guiding further diagnostic or therapeutic steps. Symptoms should be interpreted in context, alongside imaging and risk scores.