Читать книгу Practical Cardiovascular Medicine - Elias B. Hanna - Страница 189

Hubbard et al. identified five clinical parameters that predict severe (three-vessel or left main) CAD, beside age: male sex, typical angina, diabetes, insulin dependency, prior MI by history or ECG.¹⁵ A 40-year-old patient with four or more of these parameters, or a 60-year-old patient with three or more of these parameters, has a probability of severe CAD of over 40% (e.g., a 60-year-old diabetic man with typical angina). Such symptomatic patients are appropriately referred directly to coronary angiography or CTA without stress testing, as it is highly unlikely that the latter will be normal and, if normal, it may represent a false negative test.¹⁶

Other clinical features are predictive of severe CAD and may justify direct referral to angiography (class I for severe angina):^13,17,18

 High-probability angina that is severe or frequent (e.g., ≥daily). A severe angina is likely to require revascularization for symptom control regardless of stress test results or extent of CAD, as standalone medical therapy is less effective than PCI for symptom control of class III or IV angina.

 HF that is likely ischemic (HF with angina, flash pulmonary edema, or older age/combination of risk factors).

 Q waves or primary ST-T abnormalities on the baseline ECG, or regional wall motion abnormalities on echo.