Cor Vasa 2018, 60(6):e563-e568 | DOI: 10.1016/j.crvasa.2018.06.007

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

Radek Válek^a, Karel Mědílek^b,*, Josef Bis^b, Jiří Nový^a, Jiří Cyrany^a, Josef Šťásek^b

^a Interní oddělení, Oblastní nemocnice Jičín a.s., Jičín, Česká republika

^b I. interní kardioangiologická klinika, Lékařská fakulta Hradec Králové, Univerzita Karlova a Fakultní nemocnice Hradec Králové, Hradec Králové, Česká republika

Introduction: Coronary angiography (CA) is a gold standard for diagnosis of occlusive coronary atherosclerosis in patients with high pre-test probability of ischemic heart disease (IHD PTP) and in patients with medium pre-test probability, in whom a prognostically significant ischemia is detected during a stress test. The imaging stress tests are preferred to the exercise 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 IHD between April and August 2016 was retrospectively analyzed in the cardiocenter of University Hospital Hradec Králové. The patient risk profile and use of cardiac stress tests and relation of their results to the CA findings were evaluated. The CA result was considered as positive if ≥50% stenosis of coronary artery in at least one of the coronary territory 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%), exercise electrocardiograms prevailed 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 exercise 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 have medium risk of IHD. The patient history alone is a weak predictor of IHD. The stress tests for detection of ischemia are performed scarcely with the dominance of exercise electrocardiogram, which is not reliable enough for ischemia detection in the clinical practice. The imaging stress tests are not used to a sufficient extent and the rate of negative elective CAs is high in the analyzed study population.

Keywords: Negative coronary angiography; Stable angina pectoris; Stress test

Received: February 9, 2018; Revised: June 27, 2018; Accepted: June 28, 2018; Published: December 1, 2018  Show citation