title: Predictive value of angina to detect coronary artery disease in patients with severe aortic stenosis aged 50 years or older.
abstract: OBJECTIVE
  The objective of this study is to evaluate the value of angina pectoris as a predictor of CAD (coronary artery disease) in patients with AS (aortic stenosis) during and beyond the 5th decade of life.
  
  
  METHODS
  The study population consisted of 186 consecutive patients with AS and > or = 50 years of age, referred for surgical aortic valve replacement (AVR) between June 1989 and September 2004. Routine coronary angiography was performed for all patients. One hundred and one patients were males (54.3%) and 85 were females (45.7%), and the mean age was 66 +/- 8 years. One hundred and twenty-four patients (66.7%) had angina. The maximum transvalve gradient was 89.4 +/- 27.6 mmHg, and the aortic valve area measured 0.59 +/- 0.17 cm2. We calculated the sensitivity, specificity, positive and negative predictive values, as well as the likelihood ratio of a positive test result for angina in predicting the presence of CAD.
  
  
  RESULTS
  Ninety-three patients (50%) had CAD. Of the 124 patients with angina, 68 (54.8%) had CAD, whereas of the 62 patients without angina, 25 had CAD (40.3%) (p=0.087). Therefore, the diagnostic sensitivity of angina to detect CAD was 73.1%, specificity was 39.7%, positive predictive value was 54.8%, negative predictive value was 59.6%, and the likelihood ratio of a positive test result was 1.6.
  
  
  CONCLUSIONS
  Angina pectoris is not a good predictor of CAD in patients with AS who are more than 50 years of age.
authors.affiliation: Instituto Nacional de Cardiologia Laranjeiras, Fundacor, Rio de Janeiro, RJ, Brazil.
authors.forename: Aline Alves Vargas
authors.initials: AA
authors.lastname: Gonçalves
authors.forename: Fabíola Lúcio
authors.initials: FL
authors.lastname: Cardão
authors.forename: Maria Gabriela Gomes
authors.initials: MG
authors.lastname: Soares
authors.forename: André
authors.initials: A
authors.lastname: Weksler
authors.forename: Clara
authors.initials: C
authors.lastname: Weksler
authors.forename: Bernardo Rangel
authors.initials: BR
authors.lastname: Tura
authors.forename: Paulo Roberto Dutra
authors.initials: PR
authors.lastname: da Silva
authors.forename: Antônio Sérgio Cordeiro
authors.initials: AS
authors.lastname: da Rocha
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000150:complications*; D001024:Aortic Valve Stenosis / Q000150:complications*; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index