Chest, Vol 82, 416-421, Copyright © 1982 by American College of Chest Physicians

ARTICLES

Regional coronary anatomy in rest angina. Comparison of patients with rest and exertional angina using quantitative coronary angiography

JR Wilson, JL Martin, WJ Untereker and JW Hirshfeld Jr

To determine if patients with rest angina have more severe regional ischemia than patients with exertional angina, we compared the severity of left coronary artery (LCA) stenosis in 29 patients with transient anterior ischemic ST-T changes at rest, and 30 patients with anterior ST changes only during exertion. The percentage diameter stenosis was measured with Vernier calipers as (2 x lesion diameter x 100 percent)/(prestenotic + poststenotic diameter). There was no difference between the two groups in the mean diameter stenosis of unoccluded LCA vessels either when all vessels were compared (rest: 69 +/- 12 percent; exertional: 70 +/- 13 percent [p = NS]) or when only the maximal stenosis in each patient was compared (rest: 74 +/- 10 percent; exertional: 75 +/- 12 percent [p = NS]). Total occlusion of at least one major vessel of the LCA also occurred with similar frequency in patients with rest (6/29) and exertional (12/30) angina (p = NS). However, collateral development distal to 76-100 percent LCA lesions was significantly less frequent in rest angina (4/21 vessels [19 percent]) than in exertional angina (21/30 vessels [70 percent]), (p less than .03). We conclude that patients with rest angina do not have more severe coronary stenosis than patients with exertional angina, but frequently may have more severe regional ischemia due to reduced collaterization of jeopardized myocardium.