Schneider R M, Seaworth J F, Dohrmann M L, Lester R M, Phillips H R, Bashore T M, Baker J T
Am J Cardiol. 1982 Oct;50(4):682-8. doi: 10.1016/0002-9149(82)91219-x.
Eighty men (group A) with clinical coronary artery disease underwent coronary angiography regardless of symptoms and previous therapy because they had a positive treadmill exercise test in stage I or II of the Bruce protocol. Thirty-four other men (group B) who also had an early positive treadmill test underwent coronary angiography because they had disabling angina pectoris despite medical therapy. We found left main coronary artery stenosis of 50% or greater of the vessel diameter in 28% of group A and 35% of group B (p greater than 0.3). In contrast, only 10% of 93 other catheterized patients who had treadmill tests that were not early positive had left main coronary disease (p less than 0.001). Fifty-four patients from group A who did not have left main stenosis of 50% or greater were treated medically. In this subgroup, 85% had 2 or 3 major coronary vessels with 75% or greater stenosis. These patients had a 36 month survival rate of 89.2%. We conclude that an early positive treadmill test identifies patients who have an increased likelihood of having left main coronary stenosis, even if they are minimally symptomatic. To identify left main coronary stenosis, catheterization may be justified in patients whose angina pectoris has been mild or not intensively treated when they have an early positive treadmill response. After left main coronary stenosis has been excluded, these patients may be treated medically with a low mortality.
80名临床诊断为冠心病的男性（A组），无论有无症状及既往治疗情况，因在布鲁斯方案I期或II期平板运动试验呈阳性而接受冠状动脉造影。另外34名男性（B组）同样平板运动试验早期呈阳性，因尽管接受药物治疗仍有严重心绞痛而接受冠状动脉造影。我们发现A组28%、B组35%的患者左主干冠状动脉狭窄达血管直径的50%或以上（p大于0.3）。相比之下，93名其他接受导管检查的患者中，平板运动试验未早期呈阳性者仅有10%有左主干病变（p小于0.001）。A组中54名左主干狭窄未达50%或以上的患者接受药物治疗。在该亚组中，85%的患者有2支或3支主要冠状动脉狭窄达75%或以上。这些患者36个月生存率为89.2%。我们得出结论，平板运动试验早期呈阳性可识别出左主干冠状动脉狭窄可能性增加的患者，即使他们症状轻微。对于平板运动试验早期呈阳性、心绞痛症状轻微或未接受强化治疗的患者，为明确左主干冠状动脉狭窄，进行导管检查可能是合理的。排除左主干冠状动脉狭窄后，这些患者可接受药物治疗，死亡率较低。
