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Routine coronary angiography for effort angina
M V Jelinek1, N G Becker, W F Ryan
1Cardiac Investigation Unit, St Vincent's Hospital, Fitzroy, VIC.
Insights
Coronary angiography improves survival for patients with effort angina, outperforming exercise testing in identifying high-risk individuals. Bypass surgery further enhances long-term survival chances for these patients.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Medicine
Background:
- Effort angina management requires accurate risk stratification.
- Exercise testing and coronary angiography are key diagnostic tools.
Purpose of the Study:
- To compare the diagnostic and prognostic value of exercise testing versus coronary angiography.
- To evaluate their roles in managing patients with effort angina.
Main Methods:
- Retrospective follow-up study of 434 patients with effort angina.
- Analysis of patient survival based on diagnostic procedures and interventions.
Main Results:
- Coronary angiography and ST segment depression on exercise testing predicted survival.
- Five-year survival was 96% with angiography vs. 86% without.
- Medical management without angiography showed higher mortality in specific subgroups.
Conclusions:
- Coronary angiography is superior to exercise testing for identifying high-risk effort angina patients.
- Coronary bypass surgery significantly improves five-year survival in these patients.
Objective:
To compare the value of exercise testing and coronary angiography in the management of patients with effort angina.
Design:
A retrospective follow-up study.
Setting:
A university teaching hospital.
Patients:
Four hundred and thirty-four patients with a history of angina, who developed pain or ST segment changes during an exercise test and who were followed-up at up to nine years after their exercise test.
Interventions:
Coronary angiography was offered to patients for disabling angina only. Bypass surgery was generally offered to patients with multiple vessel coronary artery obstruction.
Main Outcome Measure:
Patient survival.
Results:
Stepwise regression analysis based on the Cox proportional hazards model indicated that the decision to perform coronary angiography (P less than 0.001) and the amount of ST segment depression on exercise testing (P less than 0.01) were predictors of survival. With ST segment depression set at 1 mm and age set at 53.5 years (both sample median values) the probability of survival at five years was 86% in patients who did not undergo coronary angiography compared with 96% in patients who did undergo angiography. There were eight deaths in 59 patients who did not show any ST segment depression during the exercise test and who were treated medically without coronary angiography.
Conclusions:
Coronary angiography is a superior technique to exercise testing for detecting patients with effort angina who are at high risk of premature mortality. Coronary bypass surgery makes a big improvement in the chance of five-year survival in such patients.