Dentification of High Risk Coronary Anatomy by Means of Exercise Test Variables

To determine whether exercise test variables could detect the presence of left main, three-vessel or double-vessel coronary artery disease involving left anterior descending artery (LAD), 119 exercise test variables were compared with the findings of coronary arteriography in 350 patients, of whom 200 had a previous myocardial infarction (Mİ). ?ST/?HR was the most sensitive variable for detecting left main coronary artery (LMCA) disease in the patients without a previous MI (n=l50), with a sensitivity of 100% and a specificity of 62%. It was also the most sensitive variable for the detection of three-vessel disease and three-vessel or two-vessel disease involving LAD in this group with sensitivities of 84% and 79%, and specificities of 62% and 62%, respectively. In the group of patients with a previous anterior MI (n= l00), the increase in systolic blood pressure recovery ratio (SBP-RR) was found to be the most sensitive variable for identifying the patients with LMCA or three-vessel disease and LMCA, three-vessel disease or two-vessel disease involving LAD with sensitivities of 63% and 49%, specificities of 52% and 76%, respectively. In the group of patients with a previous inferior MI (n=100), ?ST/?HR was found to be the most sensitive variable for detecting the patients with LMCA or three-vessel disease and LMCA, three-vessel disease or two-vessel diesase involving LAD with sensitivities of 71% and 55%, and specificities of 74% and 74%, respectively. It is concluded that in the assessment of an exercise test the use of ?ST/?HR and SBP-RR in addition to the traditional variables increases the diagnostic yield of the test for identification of high risk coronary anatomy.