Cardiac vs Non-Cardiac Chest Pain A 8 Year Multicenter Outcomes Analysis
Background: Chest pain is a common yet diagnostically complex presentation in cardiology, requiring accurate differentiation between cardiac and non-cardiac etiologies. Despite advances in diagnostic tools, significant variability persists in etiology classification and management.
Objectives: This multicenter study aimed to characterize the prevalence, predictors, and center-level variability of chest pain etiology in outpatient cardiology settings.
Methods: We analyzed 838 consecutive patients presenting with chest pain across four tertiary cardiology centers (2017–2025). Cardiac vs. non-cardiac etiology was adjudicated using structured electronic health record data, including clinical history (ATCD), examination findings (EXM), and ECG results. Multivariable logistic regression identified predictors of cardiac chest pain, with sensitivity analyses for age, sex, and valvular disease.
Results: Cardiac etiology accounted for 49.2% (n=412) of cases, predominantly ischemic (79 IDM, 49 atrial fibrillation), while 4.4% (n=37) were non-cardiac (e.g., musculoskeletal, psychiatric). A high proportion (43.6%, n=365) remained unclassified due to documentation gaps. Key predictors of cardiac chest pain included age >60 (aOR=3.1, 95% CI: 2.2–4.4), known cardiovascular disease (aOR=2.4, 95% CI: 1.8–3.2), and valvular pathology (OR=2.7, 95% CI: 1.3–5.8). Females disproportionately represented non-cardiac DT (43.2% vs. 48.6% cardiac; p=0.03). Center-level variability ranged from 45–52% cardiac chest pain prevalence (p=0.02), reflecting potential referral or documentation biases.
Conclusions: In this large cardiology cohort, cardiac causes dominated chest pain presentations, with age, comorbidities, and valvular disease serving as robust predictors. High rates of unclassified cases underscore the need for standardized documentation. These findings support tailored risk stratification, particularly for older patients and those with valvular disease, while highlighting sex-specific diagnostic considerations.
