Clinical study
Identification of patients with left main and three vessel coronary disease with clinical and exercise test variables

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Abstract

To determine whether clinical and exercise test variables either separately or in combination could reliably detect the presence of left main or three vessel coronary disease, 5 clinical and 11 exercise test variables were compared with the findings of coronary arterlography in 436 patients. Patients with left main coronary artery disease (n = 35) had an earlier onset of S-T segment depression (2.1 ± 1.4 versus 2.8 ± 1.7 min, p < 0.05), which was more prolonged (8.7 ± 3.6 versus 6.9 ± 3.3 min, p < 0.05) and appeared in a greater number of electrocardiographic leads (6.4 ± 2.2 versus 5.0 ± 2.2 leads, p < 0.001), than did patients with three vessel coronary disease (n = 89). Individual clinical or exercise test variables were unable to detect left main coronary disease because of their low sensitivity or predictive values. The pattern of 2 mm or greater downsloping S-T segment depression—which starts in stage 1, lasts at least 6 minutes into recovery and is displayed in at least five electrocardiographic leads—was highly predictive (74 percent) and reasonably sensitive (49 percent) for the detection of either left main or three vessel coronary disease. These criteria have a sensitivity of 74 percent and predictive value of 32 percent for the detection of isolated left main coronary artery disease.

It is concluded that combining several exercise test variables facilitates the detection of severe coronary disease. The specific presence of left main coronary artery disease nevertheless remains largely unpredictable even with this approach.

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