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Antecedent angina: a predictor of residual stenosis after thrombolytic therapy
B A Bergelson1, N A Ruocco, T J Ryan
1Evans Memorial Department of Clinical Research, Boston University Medical Center, Massachusetts.
Insights
Patients experiencing antecedent angina before myocardial infarction may have significant residual stenosis. This suggests routine coronary angiography is warranted for this high-risk group to prevent repeat ischemic events.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Significant residual stenosis post-thrombolytic therapy increases risk of recurrent ischemic events.
- Prompt angiography and revascularization are considered for high-risk patients.
Purpose of the Study:
- To determine if antecedent angina predicts significant residual stenosis after thrombolytic therapy.
- To assess the utility of antecedent angina in identifying patients for routine coronary angiography.
Main Methods:
- Retrospective review of coronary angiograms from 82 patients post-thrombolytic therapy.
- Comparison of residual stenosis and multivessel disease between patients with and without antecedent angina.
Main Results:
- Patients with antecedent angina showed higher mean stenosis (74% vs. 58%) and more multivessel disease (44% vs. 5%).
- Antecedent angina demonstrated high sensitivity (75%) and specificity (96%) for predicting significant residual stenosis.
- Positive predictive accuracy for antecedent angina was 98%.
Conclusions:
- Antecedent angina is a strong predictor of significant residual stenosis after thrombolytic therapy.
- Identifying patients with antecedent angina can help select high-risk individuals for routine coronary angiography.
- This approach may improve management and reduce the risk of repeat ischemic events.
Abstract:
Patients with a significant residual stenosis after thrombolytic therapy are believed by many to be at increased risk for repeat ischemic events and may be candidates for prompt angiography and revascularization. To test the hypothesis that patients with antecedent angina (Canadian classes I to IV, greater than or equal to 24 h before myocardial infarction) are more likely to have a significant residual stenosis (greater than or equal to 60% diameter reduction) than are those without antecedent angina, the coronary angiograms of 82 consecutive patients undergoing routine angiography after thrombolytic therapy were reviewed. Compared with the patients without antecedent angina, the group with antecedent angina had an increased mean stenosis (74% versus 58%) and more multivessel disease (44% versus 5%). The sensitivity and specificity of a clinical history of antecedent angina predicting the presence of a significant residual stenosis were 75% and 96%, respectively; the positive predictive accuracy was 98%. These data suggest that antecedent angina can be used to identify a high risk subgroup whose condition may warrant routine coronary angiography.