Prediction of "Critical" Coronary Disease: Are the "Consensus Conference" Guidelines Adequate?

Presenting features of 100 patients with significant left main coronary stenosis (LMCS) were reviewed. All presented with angina — on minimal exertion in 45, moderate exertion in 38, and severe exertion in 6 — and 11 had unstable angina. Although the resting ECG was normal in 44, exercise testing was positive in 92 % of patients tested. The authors conclude that symptoms and the resting ECG alone are unhelpful in predicting "critical" coronary disease. However, application of a management plan similar to that suggested by the Consensus Conference on coronary artery surgery would have selected the vast majority of such patients for angiography.