Clinical Indicators of Left Main Coronary Artery Disease in Unstable Angina

Abstract

Two hundred consecutive catheterized patients with unstable angina pectoris were reviewed to find clinical and noninvasive indicators of left main coronary artery disease (greater than or equal to 50% lesion). Thirty-five patients (17.5% of total) had left main coronary artery disease. There were no differences between patients with and without left main coronary artery disease in age, sex, results of resting electrocardiogram, congestive heart failure, dyspnea during pain, duration of longest pain, arrhythmias, response to medical therapy, or other risk factors. Crescendo angina pectoris (worsening of pre-existing angina), transient ST-segment depression with pain, simultaneous anterior and inferior ST changes during pain, and fluoroscopic calcification of the left main coronary artery were all significantly more common in patients with left main coronary artery disease. However, low sensitivity or low predictive value, or both, limit the usefulness of these clinical predictors. Left main coronary artery disease cannot be reliably predicted in patients with unstable angina pectoris before coronary arteriography.

Left main coronary artery disease in adults younger than 50 years: A comparison with older patients

“…This rate is comparable to rates found in previous studies [3,5,7,[11][12][13][14]; in those studies the rate of LMCA stenosis found during angiography (using Ն 50% stenosis of the LMCA as the criterion for significant obstruction) varied from 2.5% to 17.5%. The average severity of the stenosis in these 200 patients was 65 Ϯ 15%.…”

Wellens' syndrome and other electrocardiographic changes in a patient with a left anterior descending artery subocclusion associated with a left main coronary artery subocclusion

“…Patients with unstable angina have a higher incidence of left main coronary artery (LMCA) and proximal left anterior descending (LAD) coronary artery disease compared to patients with stable angina pectoris [23,24]. In 1982, Wellens and colleagues [25] described two electrocardiographic patterns that were predictive of critical narrowing of the proximal LAD artery, and were subsequently termed Wellens' syndrome [26][27][28].…”

Prospective Evaluation of a Clinical and Exercise-test Model for the Prediction of left Main Coronary Artery Disease

“…Am analysis of the application of Bayes' theorem to sequential testing in the noninvasive diagnosis of coronary artery disease. Am J Cardiol 54: [43][44][45][46][47][48][49]1984 APPENDIX The entire model can be summarized in an equation that allows calculation of the probability of left main coronary artery disease for an individual patient on the basis of the patient's age, the presence or absence of typical angina, the number of millimeters of ST-wave depression on exercise testing, and the prevalence of left main coronary artery disease in the local patient population:…”

“…Unfortunately, clinical indicators that have been found to be more common with left main coronary artery disease, such as crescendo angina and diffuse ST depression with concurrent chest pain, have low predictive values. 48 Exercise test findings such as ST depression, short exercise duration, and exertional hypotension are statistically associated with left main disease} 2, 3, 11, 12, 16, 26, 28, 32, 35, 36, 39, 41-43, 45,51,52,[55][56][57] but no single exercise test factor or group of factors has sufficient diagnostic accuracy to be the sole determinant of whom to select for catheterization. 19, 20 We therefore attempted to develop a simple model that could predict the probability of left main coronary artery disease from a combination of clinical and exercise test variables.…”