Comparison of laboratory parameters and coronary angiographicfindings in patients presenting to the emergency department with chest pain, and their relationship with coronary slow flow

Aim: One of the most common reasons for visits to the emergency department (ED) is chest pain. Patients who do not receive a definitive diagnosis often return to EDs with recurring complaints. After excluding non-cardiac causes, these patients should undergo further evaluation. Coronary slow flow (CSF), a cardiac cause, is defined as a pathological slowing of coronary blood flow without the presence of epicardial coronary artery disease. Recent studies suggest that CSF is a specific entity and should be considered a clinical syndrome rather than just an angiographic phenomenon. In our study, we aimed to compare the laboratory parameters of patients identified with CSF following coronary angiography with those who had entirely normal coronary flow. Materials and Method: For this study, data were retrospectively collected from patients who presented to the Emergency Department of Balıkesir University Hospital with chest pain between January 1, 2018, and December 31, 2023, and underwent coronary angiography following appropriate clinical evaluation. After coronary angiographies performed by cardiologists, 107 patients diagnosed with primary CSF were included as the study group, while 108 individuals with normal coronary arteries and no detected pathology were included as the control group. Basic demographic, laboratory, clinical, and angiographic parameters were compared between the two groups to identify potential predictors of CSF. Results: When evaluating dominance in our study, a higher rate of RCA (right coronary artery) dominance was observed in the control group, whereas a higher rate of Cx (circumflex artery) dominance was detected in the study group. The difference between the groups was also statistically significant. In comparison with the control group, the elevated levels of CRP (C-reactive protein), an inflammatory response marker, were found to be statistically significant in the study group. The CRP/albumin ratio, which is determined by dividing the CRP level by the albumin level, is an established scoring system used to assess the degree and activity of inflammatory diseases. It is considered a more useful indicator of inflammation than using CRP or albumin alone. In our study, this ratio was found to be statistically significant in the study group. Conclusion: Patients with CSF frequently visit emergency departments due to recurring chest pain, which significantly impacts their quality of life. Additionally, CSF should not be considered solely as an angiographic diagnosis but as a major clinical condition that may lead to life-threatening arrhythmias and sudden cardiac death. In our study, we aimed to identify a parameter that could predict CSF in patients presenting to the ED with chest pain. Upon examining the tests performed in the control and study groups, inflammatory markers, specifically CRP and the CRP/albumin ratio, were found to be significantly higher in the study group. These parameters, which can be easily obtained in the emergency department, may be useful in predicting CSF. Keywords: Emergency Department, Chest Pain, Coronary Slow Flow, Inflammation