Pathomorphologic features of the coronary anatomy in patients with stable angina pectoris
Introduction. Coronary angiographic investigation defined as an international standard in patients with cardiovascular diseases. However, according to current standards, the coronary angiography performance at low (I-II) stable angina functional class defines as an optional (elective) study.
Recent clinical studies show the mandatory determination of the hemodynamic significance of each stenosis and myocardial ischemia objective evidences before PCI procedure in patients with stable coronary artery disease. However, this does not mean the uselessness of the angiographic results; on the contrary, the coronary angiography plays the role of verification and essential coronary lesion determination.
Objectives: the features of coronary lesion determination by coronary angiographic method in patients with coronary artery disease and I-II functional class stable angina pectoris.
Material and methods. The coronary angiography of 3234 patients was performed, including 1475 (45,6%) of planned coronary angiographies to patients with stable coronary artery disease with clinic signs of myocardial ischemia. The myocardial ischemia signs were estimated by stress-test veloergometry data.
All cases of 782 patients with I-II functional class stable angina pectoris diagnosis were selected, that represented 24,2% of total amount of the coronary angiographies. It compares clinic characteristics of angina and coronary lesion level in all patients.
Results. In 215 (27,49±1,60)% clinical cases it has been found the lack of the significant coronary artery atherosclerotic lesion. So, it was different disease in over a quarter of patients with low functional class of stable angina, which named as a coronary X syndrome, it has another approaches and treatment strategy.
It is established that the significant atherosclerosis of coronary arteries and unfavorable prognosis was present in 109 (13,94±1,24)% of patients with coronary artery disease and I-II functional class angina pectoris, which requires revascularization, regardless minor clinical symptoms.
It should be noted, that significant hemodynamic lesions of left main coronary artery were present in 15 (1,92±0,49)% of patients, that will require urgent decision for the coronary revascularization. It was found in one-two vessels disease (2 and 3 patients accordingly), that is not necessary of the multivessel coronary pathology for the presence of dangerous left main lesions.
The correlation analysis between the occurrence of left main lesions and degree of the coronary injuries was made, the moderate non-significant statistical links established, proving the possibility of left main disease at any atherosclerotic disease and the necessity of initial coronary angiography performing for the exclusion of dangerous coronary disease even at the low functional class of angina.
Conclusion. 1. The various degree of coronary pathology between clear arteries and significant multivessel disease in 12,7% - 15,2% of cases was found, analyzing 782 coronary angiographies of patients with coronary artery disease and low (I-II) functional class angina pectoris. 2. There is a left main coronary artery injury from 1,5% to 2,4% of cases, and on the contrary clear coronary arteries (coronary X syndrome) appears in 25,9% - 29,1% of patients with I-II functional class of angina pectoris, that in any case cardinal changes in strategy and treatment tactics is required. 3. Changes in the coronary angiography indications for patients with coronary artery disease and I-II functional class angina pectoris need to be given, presenting it as a primary necessary diagnostics method.