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August 1992

Angiographic Patterns and Severe Coronary Artery Disease: Exercise Test Correlates

Author Affiliations

From the Cardiology Section, Veterans Affairs Medical Center, Long Beach, Calif. Dr Ribisl is now with the Department of Health and Sport Science, Wake Forest University, Winston-Salem, NC. Dr Froelicher is now with the Department of Cardiology, Veterans Administration Medical Center, Palo Alto, Calif.

Arch Intern Med. 1992;152(8):1618-1624. doi:10.1001/archinte.1992.00400200056010

In a Veterans Affairs Medical Center, we studied 607 male patients to determine whether patterns and severity of coronary artery disease could be predicted by means of standard clinical and exercise test data. We found significant differences in clinical, hemodynamic, and electrocardiographic measurements among patients with progressively increasing disease severity determined by angiography. Left main disease produced responses significantly different from those of three-vessel disease only when accompanied by a 70% or greater narrowing of the right coronary artery. Discriminant function analysis revealed that the maximum amount of horizontal or downsloping ST depression in exercise and/or recovery was the most powerful predictor of disease severity, with 2-mm ST depression yielding a sensitivity of 55% and a specificity of 80% for prediction of severe coronary artery disease (three-vessel disease plus left main disease). Patients with increasingly severe disease also demonstrated a greater frequency of abnormal hemodynamic responses to exercise.

(Arch Intern Med. 1992;152:1618-1624)