title: Prevalence and distribution of coronary disease in claudicants using 12-lead precordial stress electrocardiography.
abstract: OBJECTIVE
  to evaluate the prevalence of coronary artery disease (CAD) by means of modified stress electrocardiography in patients presenting with intermittent claudication.
  
  
  METHODS
  three hundred consecutive patients (188 male) with intermittent claudication (post-exercise ankle brachial index <0.8), and 100 age and sex-matched controls, were assessed for CAD with resting and stress 12-lead-precordial ECG. A history of angina and previous myocardial infarction (MI) was recorded.
  
  
  METHODS
  recent (<1 month) MI; unstable angina; prior coronary intervention; arrhythmias; conduction abnormalities; uncontrolled hypertension; heart failure, digoxin therapy, and inability to perform tests.
  
  
  RESULTS
  based on antecedent angina, MI and abnormal resting ECG, CAD prevalence was 47% in claudicants and 6% in controls; on 12-lead-precordial ECG stress testing, CAD prevalence was 46% (95% CI: 40.1-51.7%) in claudicants and 11% (95% CI: 4.8-17.2%) in controls (both p <0.0001). Only 67% of claudicants (n=141) with antecedent angina, MI or an abnormal resting ECG, met the criteria of CAD on stress testing; also 28% of claudicants without antecedent angina, MI and a normal resting ECG (n=159) had evidence of CAD. The odds ratio for CAD in claudicants was 6.9. Based on 12-lead-precordial ECG stress testing we detected the presence of: one-, two- and three-vessel disease in 14.7% (95% CI: 10.6-18.7%), 19% (95% CI: 14.5-23.5%) and in 12.3% (95% CI: 8.6-16%) of claudicants; and in 8, 3 and 0% of controls, respectively.
  
  
  CONCLUSIONS
  forty six percent of patients with intermittent claudication had concomitant CAD, and 31% two- or three-vessel disease. In the presence of claudication the odds ratio for CAD is 6.9 (95% CI: 3.5-13.4) and for two- or three-vessel disease 14.8. Non-invasive modified stress electrocardiography by enabling identification of those with multi-vessel CAD and thus by providing cardiac risk stratification may help bridge the gap between clinical evaluation and invasive coronary imaging.
authors.affiliation: Academic Vascular Surgery, St Mary's Hospital, Imperial College, London, U.K.
authors.forename: T N
authors.initials: TN
authors.lastname: Sonecha
authors.forename: K T
authors.initials: KT
authors.lastname: Delis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D004562:Electrocardiography / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D007511:Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D008131:London / Q000453:epidemiology; D035002:Lower Extremity / Q000098:blood supply / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence