Analysis of elective coronary angiography findings in patients with suspected angina pectoris in the cardiocenter Hradec Králové - Real-life clinical practice in light of the guidelines
Abstrakt
Introduction: Coronary angiography (CA) is a gold standard of diagnosis of occlusive coronary atherosclerosis in patients with high pre-test probability of IHD (PTP) and in patients with medium pre-test probability, in whom a prognostically significant ischemia was detected during a stress test. The imaging stress tests are preferred to the stress electrocardiogram due to higher sensitivity and specificity.
The aim of this work was to analyze the profile of patients undergoing the elective CA due to suspected IHD.Study population and methods Population of 184 patients who underwent elective CA due to suspected ischemic heart disease between April and August 2016 was retrospectively analyzed in the cardiocenter at the University Hospital Hradec Králové. The patient risk profile and use of cardiac stress tests and their relation to the CA findings were evaluated.
The CA result was evaluated as positive if stenosis of coronary artery of GREATER-THAN OR EQUAL TO50% in at least one of the main coronary arteries was found.Results:Patients with medium PTP prevailed in our study population - 154 (84%), there were 6 (3%) patients with low and 24 (13%) with high PTP. 112 (61%) patients had negative and 72 (39%) positive CA finding. Stress test was performed in 43 cases (23%) and the stress electrocardiograms predominated significantly over the imaging stress tests: 37 (86%) versus 6 (14%).
In the medium-risk group, a stress test was performed in 36 (23%) patients, in 92% it consisted of stress electrocardiogram. None of the patients with low PTP had positive CA, in the medium-risk group the CA was positive in 38% and in the high-risk group in 54%.
In the patients with positive exercise electrocardiogram, the CA was positive only in 10% of cases. 44% of patients with positive and 39% of patients with negative CA had typical angina pectoris.Conclusion: Most of the patients referred for elective CA had medium risk of IHD. The patient medical history alone was not a reliable predictor of IHD.
The stress tests for detection of ischemia were performed scarcely with the dominance of stress electrocardiogram, which was not reliable in the ischemia detection in the clinical practice. The imaging stress tests were not used to a sufficient extent and the rate of negative elective CAs was high in the analyzed study population.