Abrams H L
AJR Am J Roentgenol. 1982 Jul;139(1):1-18. doi: 10.2214/ajr.139.1.1.
Coronary arteriography is properly considered the in vivo "gold standard" by which all other clinical diagnostic criteria and noninvasive tests of coronary disease are gauged. In most respects, the radiographic-morphologic findings of the coronary arteriogram are readily translated into the pathologic substrate of disease. Careful correlative studies suggest, however, that in an important group of patients the arteriogram underpredicts the degree of disease, and in a far smaller group it overpredicts. Furthermore, there is no "one" correct interpretation of the coronary arteriogram; there are striking inter- and intraindividual variations in the assessment of the degree of stenosis when experts evaluate the examinations. Despite the discrepancies in angiographic-pathologic correlation and in multiple observer analysis, coronary arteriography in its present form represents an important predictive element in assessing the prognosis for the patient with coronary disease. The distribution and degree of the lesions per se are important prognostic factors, but these take on additional force in the presence of asynergy, cardiac enlargement, congestive heart failure, or depressed ejection fraction, all of which worsen the prognosis significantly.
冠状动脉造影术被恰当地视为体内的“金标准”，据此来衡量所有其他冠心病的临床诊断标准和非侵入性检查。在大多数方面，冠状动脉造影的放射影像学形态学发现很容易转化为疾病的病理基础。然而，仔细的相关性研究表明，在一组重要的患者中，血管造影低估了疾病的程度，而在一个小得多的群体中则高估了疾病程度。此外，对于冠状动脉造影并没有“一种”正确的解读；专家评估检查时，在狭窄程度的评估上存在显著的个体间和个体内差异。尽管血管造影与病理的相关性以及多观察者分析存在差异，但目前形式的冠状动脉造影在评估冠心病患者的预后方面仍是一个重要的预测因素。病变本身的分布和程度是重要的预后因素，但在存在协同失调、心脏扩大、充血性心力衰竭或射血分数降低的情况下，这些因素会产生更大的影响，所有这些都会显著恶化预后。
