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Correlation of "critical" left coronary artery lesions with positive submaximal exercise tests in patients with chest
Insights
Patients with significant ST-segment depression on treadmill tests often have critical coronary artery disease. However, those with minimal ST changes may not require invasive coronary arteriography.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) diagnosis relies on correlating symptoms with anatomical findings.
- Treadmill exercise testing is a common non-invasive tool to assess for inducible ischemia.
Purpose of the Study:
- To correlate coronary arteriography findings with ST-segment depression levels during submaximal treadmill tests in symptomatic CAD patients.
- To determine if coronary arteriography is necessary for patients with minimal ST-segment depression.
Main Methods:
- Patients were divided into three groups based on ST-segment depression: ≥2 mm (Group I), 1.0–1.9 mm (Group II), and 0–0.9 mm (Group III).
- Coronary arteriography was performed to assess the severity and location of coronary artery lesions.
- Critical lesions included significant narrowing of the left main coronary artery (LMCA) or left main equivalent (LME).
Main Results:
- 75% of Group I patients had critical coronary lesions, including LMCA or LME.
- 82% of Group I patients had two- or three-vessel disease.
- All patients with LMCA lesions exhibited ≥2 mm ST-segment depression.
- Less than 5% of patients with critical lesions showed <1 mm ST-segment depression.
Conclusions:
- Significant ST-segment depression on treadmill tests strongly correlates with critical coronary artery disease.
- Patients with medically controllable angina and minimal (<1 mm) ST-segment depression on treadmill tests likely do not require coronary arteriography.
Abstract:
This study correlates the anatomic pathologic coronary anatomy found by arteriography in each of three groups of symptomatic patients, all with coronary artery disease, divided according to the magnitude of ST-segment depression after an adequate submaximal treadmill exercise test. Group I consists of 45 patients with ST-segement depression of 2 mm. or more, Group II of 31 patients with ST-segment depression between 1.0 and 1.9 mm., and Group III, 30 patients with 0 to 0.9 mm. ST-segment depression. Seventy-five per cent of the patients in Group I had critical lesions defined as (1) 75 per cent or greater narrowing of left main coronary artery (LMCA), (2) 75 per cent or greater obstructive left anterior descending and left circumflex coronary artery both proximal to any major branching, the so-called left main equivalent (LME) lesions, and (3) 90 per cent or more obstruction of the left anterior descending coronary proximal to any major branches. Of patients in Group I, 24 PER CENT Had LMCA lesions, 29 per cent had LAD lesions. Eight-two per cent of Group I patients had two- or three-vessel disease. All patients with LMCA lesions had 2 mm. or more ST-segment depression. Over 95 per cent of patients with "critical" lesions is less than 5 per cent in the presence of an adequate aubmaximal treadmill test that shows less than 1 mm. of ST-segment depression, it is concluded that in such patients with medically controllable angina, coronary arteriography is not necessary.