Sonecha T N, Delis K T
Academic Vascular Surgery, St Mary's Hospital, Imperial College, London, U.K.
Eur J Vasc Endovasc Surg. 2003 Jun;25(6):519-26. doi: 10.1053/ejvs.2002.1902.
to evaluate the prevalence of coronary artery disease (CAD) by means of modified stress electrocardiography in patients presenting with intermittent claudication.
three hundred consecutive patients (188 male) with intermittent claudication (post-exercise ankle brachial index <0.8), and 100 age and sex-matched controls, were assessed for CAD with resting and stress 12-lead-precordial ECG. A history of angina and previous myocardial infarction (MI) was recorded.
recent (<1 month) MI; unstable angina; prior coronary intervention; arrhythmias; conduction abnormalities; uncontrolled hypertension; heart failure, digoxin therapy, and inability to perform tests.
based on antecedent angina, MI and abnormal resting ECG, CAD prevalence was 47% in claudicants and 6% in controls; on 12-lead-precordial ECG stress testing, CAD prevalence was 46% (95% CI: 40.1-51.7%) in claudicants and 11% (95% CI: 4.8-17.2%) in controls (both p <0.0001). Only 67% of claudicants (n=141) with antecedent angina, MI or an abnormal resting ECG, met the criteria of CAD on stress testing; also 28% of claudicants without antecedent angina, MI and a normal resting ECG (n=159) had evidence of CAD. The odds ratio for CAD in claudicants was 6.9. Based on 12-lead-precordial ECG stress testing we detected the presence of: one-, two- and three-vessel disease in 14.7% (95% CI: 10.6-18.7%), 19% (95% CI: 14.5-23.5%) and in 12.3% (95% CI: 8.6-16%) of claudicants; and in 8, 3 and 0% of controls, respectively.
forty six percent of patients with intermittent claudication had concomitant CAD, and 31% two- or three-vessel disease. In the presence of claudication the odds ratio for CAD is 6.9 (95% CI: 3.5-13.4) and for two- or three-vessel disease 14.8. Non-invasive modified stress electrocardiography by enabling identification of those with multi-vessel CAD and thus by providing cardiac risk stratification may help bridge the gap between clinical evaluation and invasive coronary imaging.
通过改良的运动心电图评估间歇性跛行患者冠状动脉疾病（CAD）的患病率。
连续纳入300例间歇性跛行患者（188例男性）（运动后踝臂指数<0.8），以及100例年龄和性别匹配的对照者，采用静息和运动12导联心前区心电图评估CAD。记录心绞痛病史和既往心肌梗死（MI）病史。
近期（<1个月）MI；不稳定型心绞痛；既往冠状动脉介入治疗；心律失常；传导异常；未控制的高血压；心力衰竭；地高辛治疗；以及无法进行检查。
基于既往心绞痛、MI和静息心电图异常，间歇性跛行患者的CAD患病率为47%，对照者为6%；在12导联心前区心电图运动试验中，间歇性跛行患者的CAD患病率为46%（95%CI：40.1-51.7%），对照者为11%（95%CI：4.8-17.2%）（两者p<0.0001）。在既往有心绞痛、MI或静息心电图异常的间歇性跛行患者中，只有67%（n=141）在运动试验中符合CAD标准；在没有既往心绞痛、MI且静息心电图正常的间歇性跛行患者中，也有28%（n=159）有CAD证据。间歇性跛行患者患CAD的比值比为6.9。基于12导联心前区心电图运动试验，我们检测到间歇性跛行患者中存在单支血管病变、双支血管病变和三支血管病变的比例分别为14.7%（95%CI：10.6-18.7%）、19%（95%CI：14.5-23.5%）和12.3%（95%CI：8.6-16%）；对照者中分别为8%、3%和0%。
46%的间歇性跛行患者合并CAD，31%合并双支或三支血管病变。存在间歇性跛行时，CAD的比值比为6.9（95%CI：3.5-13.4），双支或三支血管病变的比值比为14.8。无创改良运动心电图能够识别多支血管CAD患者，从而进行心脏风险分层，可能有助于弥合临床评估与有创冠状动脉成像之间的差距。
