Selective Cine Coronary Arteriography

The clinical records of 1,000 patients who had adequate selective cine coronary arteriography were reviewed. The clinical diagnoses were made by a physician who had no knowledge of the arteriographic findings. Correlation of the clinical diagnoses with the arteriographic findings was made subsequently. Symptomatic coronary disease was accompanied by arteriographic evidence of significant obstruction of major coronary arteries in most instances. A close correlation existed between the clinical diagnosis of angina pectoris without rest pain and significant arterial obstruction (95%). A similar correlation was found between QRS evidence of myocardial infarction and severe arterial obstruction (99%). The demonstrated arterial obstruction in patients who had angina pectoris almost always was severe and usually almost total or total in one or more major vessels. In myocardial infarction the demonstrated obstruction was always severe and generally almost total or total. The correlation between clinical and arteriographic findings was moderately close in patients who had angina with symptoms at rest. The correlation between the arteriographic findings and less characteristic clinical syndromes (rest pain only, 79%, coronary failure, 78%, and especially atypical angina pectoris, 65%) was not so close. In congestive failure secondary to coronary disease, arterial obstruction was extensive unless ventricular aneurysm, mitral insufficiency, arrhythmia, arterial hypotension, or some other complication was present. Most patients thought to have noncoronary symptoms had no significant obstructive lesions. In 37% of the entire group of patients, almost all of whom had been suspected of having coronary disease by some physicians, no significant arteriographic obstruction was demonstrated; in 27% the arteriograms were normal. Diagnoses, based on appraisal of the clinical records without knowledge of the arteriographic findings, yielded 83% correlation with abnormal arteriographic findings in 700 patients thought to have coronary disease.