Chaitman B R, Bourassa M G, Davis K, Rogers W J, Tyras D H, Berger R, Kennedy J W, Fisher L, Judkins M P, Mock M B, Killip T
Circulation. 1981 Aug;64(2):360-7. doi: 10.1161/01.cir.64.2.360.
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.
在1975年至1979年参加冠状动脉外科研究并接受血管造影的20391名患者中，评估了冠状动脉狭窄大于或等于70%或左主干狭窄大于或等于50%的患病率。排除不稳定型心绞痛或心肌梗死患者后，8157名确诊心绞痛、可能心绞痛和非特异性胸痛患者的疾病患病率在男性中分别为93%、66%和14%，在女性中分别为72%、36%和6%（p<0.001）。患者的年龄、性别和胸痛特征是疾病患病率和严重程度的重要决定因素。左主干或三支冠状动脉疾病在患有确诊心绞痛的中年男性和老年女性中发生率超过50%，在患有可能心绞痛且年龄超过60岁的男性中发生率超过50%。相比之下，无论年龄大小，1282名患有非特异性胸痛的男性中左主干冠状动脉疾病发生率低于2%，1397名患有非特异性胸痛的女性中发生率低于1%。在这后一组患者中，60岁以下各年龄段的男性中左主干或三支冠状动脉疾病发生率低于5%，女性低于1%。因此，高危冠状动脉疾病在患有确诊心绞痛的中年患者和患有可能心绞痛的老年患者中很常见，但在患有非特异性胸痛的患者中很少见。诊断性无创检查和冠状动脉造影的适应证及指南可基于这些结果制定。
