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Angiographic prevalence of high-risk coronary artery disease in patient subsets (CASS)
Insights
High-risk coronary artery disease is common in patients with definite or probable angina but rare in those with nonspecific chest pain. Angiography study results can guide diagnostic testing and referral guidelines.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Coronary artery disease (CAD) prevalence varies significantly based on patient demographics and symptom presentation.
- Understanding disease prevalence in different clinical subsets is crucial for appropriate diagnostic strategies.
Purpose of the Study:
- To evaluate the prevalence of significant coronary artery stenoses (≥70% or left main ≥50%) in a large cohort undergoing angiography.
- To determine the relationship between chest pain characteristics, age, sex, and CAD severity.
Main Methods:
- Analysis of 20,391 patients from the Coronary Artery Surgery Study (1975-1979) undergoing coronary angiography.
- Exclusion of patients with unstable angina or myocardial infarction, followed by stratification based on chest pain diagnosis (definite, probable, nonspecific).
Main Results:
- Prevalence of significant CAD was 93% (men) and 72% (women) in definite angina, 66% (men) and 36% (women) in probable angina.
- Nonspecific chest pain showed low prevalence: 14% (men) and 6% (women).
- High-risk CAD (left main or three-vessel) was common in definite/probable angina but rare (<2%) in nonspecific chest pain.
Conclusions:
- Chest pain characteristics, age, and sex are key determinants of CAD prevalence and severity.
- Significant CAD is prevalent in patients with definite/probable angina, necessitating appropriate diagnostic workup.
- Patients with nonspecific chest pain have a low likelihood of high-risk CAD, potentially refining diagnostic guidelines.
Abstract:
The prevalence of coronary artery stenoses greater than or equal to 70% or left main stenosis greater than or equal to 50% was evaluated in 20,391 patients who underwent angiography in the Coronary Artery Surgery Study from 1975-1979. After the patients with unstable angina or myocardial infarction were excluded, the disease prevalence in the 8157 patients with definite angina, probable angina, and nonspecific chest pain was 93%, 66% and 14% in men and 72%, 36% and 6% in women (p less than 0.001). The age and sex of the patients and character of chest pain were important determinants of disease prevalence and severity. Left main or three-vessel coronary disease occurred in more than 50% of middle-aged men and older women with definite angina and in more than 50% of men who had probable angina and were older than 60 years of age. In contrast, left main coronary disease occurred in less than 2% of 1282 men and less than 1% of 1397 women with nonspecific chest pain regardless of age. In this latter patient subset, less than 5% of men and less than 1% of women in each decade under 60 years had left main or three-vessel coronary artery disease. Thus, high-risk coronary disease is common in middle-aged patients with definite angina and older patients with probable angina, but is rare in patients with nonspecific chest pain. Indications and guidelines for diagnostic noninvasive tests and coronary angiography could be based on these results.