Why the study?
Does the application of Consensus Conference guidelines adequately predict critical coronary disease in patients with left main coronary stenosis?
Does the application of Consensus Conference guidelines adequately predict critical coronary disease in patients with left main coronary stenosis?
Symptoms and resting ECG alone are insufficient to predict critical left main coronary stenosis, but applying Consensus Conference guidelines effectively identifies these patients for angiography.
Guidelines with exercise testing may aid angiography selection in left main stenosis missed by symptoms/ECG; leaves open prospective validation.
Presenting features of 100 patients with significant left main coronary stenosis (LMCS) were reviewed. All presented with angina--on minimal exertion in 45, moderate exertion in 38, and severe exertion in 6--and 11 had unstable angina. Although the resting ECG was normal in 44, exercise testing was positive in 92% of patients tested. The authors conclude that symptoms and the resting ECG alone are unhelpful in predicting "critical" coronary disease. However, application of a management plan similar to that suggested by the Consensus Conference on coronary artery surgery would have selected the vast majority of such patients for angiography.
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Hutchison et al. (1987) studied this question.
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