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Angiographic extent of coronary artery stenosis in patients with high and intermediate likelihood of unstable angina according to likelihood classification of American Heart Association [Anatol J Cardiol]
Anatol J Cardiol. 2007; 7(3): 287-291

Angiographic extent of coronary artery stenosis in patients with high and intermediate likelihood of unstable angina according to likelihood classification of American Heart Association

Ersin Aksay1, Özgür Karcıoğlu2, Sedat Yanturalı2, Önder Kırımlı4
1Department of Emergency Medicine, School of Medicine, Ege University, İzmir
2Department of Emergency Medicine Dokuz Eylül University, İzmir, Turkey
3Department of Emergency Medicine Dokuz Eylül University, İzmir, Turkey
4Department of Cardiology, School of Medicine, Dokuz Eylül University, İzmir, Turkey

Objective: In accordance with the AHA/ACC clinical practice guideline, the likelihood of acute ischemia caused by coronary artery disease (CAD) is to be determined as high, intermediate, or low for all patients presenting with chest discomfort. This study was conducted to estimate extent of significant CAD in patients with high and intermediate likelihood of unstable angina (UA) according to “AHA likelihood classification” Methods: Overall, 133 consecutive patients presented with symptoms or signs suggestive of UA, which was classified as of high or intermediate likelihood in Emergency Department (ED), and undergoing coronary angiography (CAG) within one week were enrolled into the study. The characteristics of the patients in either subgroup were compared in terms of the findings of the CAG. Results: In patients with high likelihood of UA (n=89), CAG revealed that 62 had significant CAD, 7 - moderate CAD, 20 - mild CAD or normal coronary angiogram. In patients with intermediate likelihood of UA (n=19), CAG revealed that 2 patients had significant CAD, and 17 - mild CAD or normal coronary angiogram. The rate of significant CAD was significantly higher in patients with high likelihood (p<0.001, LR 23.97, 95% CI 4.21-90.43). The sensitivity and specificity of having at least one of high likelihood features for detecting significant CAD were found to be 96.8% and 38.6% respectively. Conclusion: We suggest that the likelihood classification is useful for the triage of the UA patients in the ED. When supported with further studies, utilization of this classification will yield a high diagnostic accuracy in predicting or ruling out severe CAD in patients presenting with chest pain.

Keywords: Unstable angina, chest pain, coronary artery disease, emergency department, likelihood, classification, specificity and sensitivity


Amerikan Kalp Cemiyetinin olasılık sınıflamasına göre yüksek ve orta olasılıklı kararsız anjinalı hastalarda koroner arter tıkanıklığının anjiyografik yaygınlığı

Ersin Aksay1, Özgür Karcıoğlu2, Sedat Yanturalı2, Önder Kırımlı4
1Department of Emergency Medicine, School of Medicine, Ege University, İzmir
2Department of Emergency Medicine Dokuz Eylül University, İzmir, Turkey
3Department of Emergency Medicine Dokuz Eylül University, İzmir, Turkey
4Department of Cardiology, School of Medicine, Dokuz Eylül University, İzmir, Turkey

Anahtar Kelimeler: Kararsız anjina, göğüs ağrısı, koroner arter hastalığı, acil servis, olasılık, sınıflama, seçicilik ve duyarlılık


Ersin Aksay, Özgür Karcıoğlu, Sedat Yanturalı, Önder Kırımlı. Angiographic extent of coronary artery stenosis in patients with high and intermediate likelihood of unstable angina according to likelihood classification of American Heart Association. Anatol J Cardiol. 2007; 7(3): 287-291


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