Related Experiment Videos
[Severity of angina pectoris and coronary angiographic imaging]
1Kliniki Choroby Wieńcowej Instytutu Kardiologii Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowie.
Insights
The study found a weak correlation between coronary artery disease extent and symptom severity. Many patients with severe atherosclerosis had mild symptoms, and some with minimal disease experienced severe angina.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Clinical Research
Background:
- The common assumption links more extensive coronary artery disease (CAD) to more severe symptoms.
- Understanding this relationship is crucial for patient management and risk stratification.
Purpose of the Study:
- To evaluate the correlation between the extent of coronary artery lesions and the severity of coronary symptoms.
- To investigate the validity of the assumption that anatomical disease severity directly predicts symptomatic severity in patients with CAD.
Main Methods:
- Studied 300 consecutive patients with coronary artery disease (CAD).
- Assessed coronary symptoms using the Canadian Cardiovascular Society (CCS) classification.
- Quantified anatomical lesions via angiography, using the Califf's jeopardy score to estimate myocardium at risk.
Main Results:
- A significant but weak correlation (r = 0.16, p = 0.07) was observed between symptom severity (CCS) and angiographic findings (jeopardy score).
- 17% of patients with extensive coronary atherosclerosis (Califf score 10-12) were nearly asymptomatic (CCS Class I).
- One-third of patients lacked critical stenosis, yet 51% reported severe symptoms (CCS Class III, IV).
Conclusions:
- The relationship between the anatomical extent of coronary artery disease and symptom severity is not straightforward.
- Angiographic findings alone do not fully predict the severity of angina pectoris experienced by patients.
- Clinical assessment of symptoms remains vital, as anatomical disease extent does not always correlate with symptom burden in CAD.
Abstract:
The aim of the study was to evaluate commonly accepted assumption that more extensive coronary lesions correspond to more severe coronary symptoms. 300 consecutive patients with coronary artery disease (74 women and 226 men) admitted to Department of Coronary Disease in 1993/94 were studied. Coronary symptoms were assessed according to the Canadian Cardiovascular Society (CCS) classification of angina pectoris. Anatomic lesions revealed by angiography were classified as one, two or three vessel disease and also with use of Califfs jeopardy score (0-12 points) which is the simple and more precise method of estimating the amount of myocardium at risk. We found significant but rather weak correlation between severity of coronary symptoms (CCS) and angiographic findings (jeopardy score): (r = 0.16, p = 0.07). It was shown that there is the significant correlation between symptoms severity and anatomic lesions revealed by angiography. 17% of patients in spite of the extensive coronary atherosclerosis (10-12 points according to Califf) were almost asymptomatic (I class CCS). It is emphasized that one third of the patients had no critical stenosis however 51% of them presented severe coronary symptoms (III, IV class CCS).