Circulation, Vol 64, 360-367, Copyright © 1981 by American Heart Association
BR Chaitman, MG Bourassa, K Davis, WJ Rogers, DH Tyras, R Berger, JW Kennedy, L Fisher, MP Judkins, MB Mock and T Killip
The prevalence of coronary artery stenoses greater than or equal to 70% or
left main stenosis greater than or equal to 50% was evaluated in 20,391
patients who underwent angiography in the Coronary Artery Surgery Study
from 1975-1979. After the patients with unstable angina or myocardial
infarction were excluded, the disease prevalence in the 8157 patients with
definite angina, probable angina, and nonspecific chest pain was 93%, 66%
and 14% in men and 72%, 36% and 6% in women (p less than 0.001). The age
and sex of the patients and character of chest pain were important
determinants of disease prevalence and severity. Left main or three-vessel
coronary disease occurred in more than 50% of middle-aged men and older
women with definite angina and in more than 50% of men who had probable
angina and were older than 60 years of age. In contrast, left main coronary
disease occurred in less than 2% of 1282 men and less than 1% of 1397 women
with nonspecific chest pain regardless of age. In this latter patient
subset, less than 5% of men and less than 1% of women in each decade under
60 years had left main or three-vessel coronary artery disease. Thus,
high-risk coronary disease is common in middle-aged patients with definite
angina and older patients with probable angina, but is rare in patients
with nonspecific chest pain. Indications and guidelines for diagnostic
noninvasive tests and coronary angiography could be based on these results.
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Angiographic prevalence of high-risk coronary artery disease in patient subsets (CASS)
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