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Rest angina with transient S-T segment elevation. Correlation of clinical features with coronary anatomy
Insights
Clinical features help identify multiple-vessel coronary artery disease in patients with rest angina and transient S-T elevation. However, these features cannot distinguish between minimal disease and single-vessel disease.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Angina at rest with transient S-T segment elevation is a critical clinical presentation.
- Understanding the underlying coronary anatomy is crucial for effective patient management.
Purpose of the Study:
- To correlate clinical features with coronary angiographic findings in patients presenting with rest angina and transient S-T segment elevation.
- To determine if clinical presentation can differentiate the severity of coronary artery disease.
Main Methods:
- 44 consecutive patients with angina at rest and transient S-T segment elevation were analyzed.
- Patients were categorized into three groups based on the number of major vessels with >=70% luminal narrowing: minimal (Group I), single-vessel (Group II), and multiple-vessel (Group III) disease.
- Clinical features, demographics, and risk factors were compared across the groups.
Main Results:
- Multiple-vessel disease (Group III) was associated with a higher incidence of angina on effort and abnormal baseline electrocardiograms compared to minimal or single-vessel disease.
- Age, sex, risk factors, symptom onset to study time, and arrhythmias during ischemia did not differ significantly between groups.
- The absence of angina on effort and a normal baseline ECG did not reliably differentiate between minimal and single-vessel disease.
Conclusions:
- Clinical features can identify patients with multiple-vessel coronary artery disease among those with rest angina and transient S-T elevation.
- Clinical assessment alone is insufficient to differentiate between minimal coronary artery disease and single-vessel disease in this patient cohort.
Abstract:
In 44 consecutive patients with angina at rest associated with transient S-T segment elevation, clinical features were correlated with angiographic coronary anatomy. Patients were divided into three groups depending on the number of major vessels having greater than or equal to 70 per cent luminal narrowing: Group I = no or minimal disease (six patients); group II = single vessel disease (13 patients); and group III = multiple vessel disease (25 patients). The following features did not differ significantly among groups I, II or III: age, sex, risk factors, time from onset of episodes of pain at rest to study or arrhythmias during ischemic episodes. Patients in group III were more likely to have angina on effort (p less than 0.001) and an abnormal base line electrocardiogram (p less than 0.001) than patients in groups I or II. However, the absence of these features did not separate patients in group I from those in group II. In patients with angina at rest associated with transient S-T segment elevation, clinical features identify patients with multiple vessel disease but do not allow differentiation of patients with no or minimal coronary disease from patients with single vessel disease.