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[Coronary stenosis in angina pectoris with normal resting electrocardiogram]
Insights
Patients with typical angina pectoris and normal resting electrocardiograms show similar coronary artery disease severity but better left ventricular function. This suggests they may benefit more from aorta-coronary bypass grafts.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Typical angina pectoris can present with normal or abnormal electrocardiogram (ECG) findings at rest.
- Understanding arteriographic differences between these presentations is crucial for treatment decisions.
Purpose of the Study:
- To compare arteriographic abnormalities in patients with typical angina pectoris and normal versus abnormal resting ECGs.
- To assess the implications for left ventricular function and surgical intervention.
Main Methods:
- Retrospective analysis of arteriographic data from 104 patients with normal resting ECGs and 238 patients with abnormal resting ECGs (ST/T changes or transmural necrosis).
- Comparison of coronary stenosis degree, extent, distribution, and left ventricular function parameters.
Main Results:
- No significant differences in overall coronary stenosis severity, extent, or distribution between groups.
- Slightly less frequent very tight stenoses and less severe lesions in the circumflex and right coronary arteries in the normal ECG group.
- Significantly better preserved left ventricular function and lower left ventricular end-diastolic pressure in patients with normal resting ECGs (p < 0.001).
Conclusions:
- Patients with typical angina and normal resting ECGs exhibit comparable coronary artery disease burden but superior left ventricular function.
- Aorta-coronary bypass grafting may be a more favorable option for patients with typical angina and normal resting ECGs due to better ventricular reserve.
Abstract:
The arteriographic abnormalities found in 104 patients with typical angina pectoris and an electrocardiogram at rest which was normal at the time of arteriography were compared with those of 238 cases with typical angina pectoris, but with an abnormal electrocardiogram (127 having ST/T changes, 111 having transmural necrosis). There was no major difference between the two groups as far as the degree of coronary stenosis was concerned, nor in its extent and distribution. However, by comparison with the group with an abnormal electrocardiogram, very tight stenoses of the three trunks or of one trunk alone were slightly less common in the patients with a normal electrocardiogram; also, for each of the three trunks, the index of the lesion was slightly less raised, and the circumflex and right coronary arteries were slightly less commonly, affected, although the difference was not usually great enough to achieve significance. The action of the left ventricle and/or the value of left ventricular end-diastolic pressure were, however, manifestly better conserved in those with a normal electrocardiogram (p less than 0.001). An aorta-coronary bypass graft is more likely to be indicated in this group of patients.