Quantitative relation of electrocardiographic and angiocardiographic measures of risk in patients with coronary atherosclerosis. Simvastatin/Enalapril Coronary Atherosclerosis Trial (SCAT) Investigators.

OBJECTIVE

To correlate angiocardiographic and electrocardiographic (ECG) measures of risk in coronary artery disease (CAD) patients.

SETTING

Baseline substudy of the Simvastatin/Enalapril Coronary Atherosclerosis Trial (SCAT), a 2 x 2 factorial, randomized, controlled trial of CAD regression.

PATIENTS

One hundred and twenty-three CAD patients, 113 males and 10 females; average age, 59 years.

METHODS

Bivariate correlations of multiple quantitative measures of epicardial coronary angiographic luminal narrowing (quantitative coronary angiography [QCA]) and body surface ECG maps of the sum of the decrease in the potential time integral of the ST segment (SST decrease) between rest and symptom-limited exercise and between rest and 1 and 5 mins postexercise recovery.

RESULTS

The average number of epicardial coronary segments analyzed per patient was 12. The mean diameter averaged 2.78 mm; the minimal diameter, 2.01 mm. The mean percentage coronary stenosis averaged 29.6% and the most severe averaged 62.9%. sigma ST decrease averaged -5323 microV.s between rest and peak exercise and recovered slowly, averaging -5117 microV.s at 1 min postexercise and -4562 microV.s at 5 mins. No QCA measure correlated with any ECG variable (range of r, 0.002 to -0.179; not significant).

CONCLUSIONS

Among CAD patients there are no close, or causal, relations between angiographic measures of anatomic epicardial coronary atherosclerosis and ECG functional measures of exercise-induced myocardial ischemia. These data suggest that demonstrated values of stress ECG and coronary angiography for the prediction of clinical risk in CAD patients are largely independent of each other.