[Clinical characteristics of angina pectoris in patients of coronary artery disease complicated with renal stenosis and the diagnostic value thereof: analysis of 2820 cases].
OBJECTIVE
To analyze the characteristics of angina symptom complex of patients with coronary artery disease (CAD) complicated with renal stenosis, and to analyze their sensitivity and specificity of angina symptom complex for the diagnosis of CAD.


METHODS
The medical records of 2820 in-hospital patients who underwent coronary angiography and renal angiography simultaneously during the period from Jan 1998 to May 2005 and could be diagnosed as with CAD or renal stenosis with the stenotic degree more than 50% of the coronary or renal artery in angiography, were analyzed. The diagnosis of CAD was based on the 3 groups of symptoms recommended by American College of Cardiology/American Heart Association: (1) substernal chest discomfort with a characteristic quality and duration, (2) chest pain provoked by exertion or emotional stress, and (3) chest pain that can be relieved by rest or nitroglycerin.


RESULTS
243 of the 2820 patients had renal stenosis and 2577 of the 2820 patient did not have renal stenosis. The prevalence rates of CAD and hypertension were higher in the renal stenosis group and in the patients without renal stenosis. To diagnose CAD with any one of the 3 groups of above mentioned angina symptom complex, the sensitivity rates were 94.2%, 69.7%, and 75.5% respectively, the specificity rates were 14.3%, 40.0%, and 25.7% respectively, the positive predictive values were 86.7%, 87.3%, and 85.8% respectively, and the negative predictive values were 29.4%, 18.2%, and 15.0% respectively. To diagnose CAD by the symptoms of groups (2) plus (3), (1) plus (2), and (1) plus (3) the sensitivity rates were 68.8%, 56.7%, and 72.6% respectively, specificity rate were 40.0%, 62.9%, and 45.7% respectively, positive predictive values were 87.2%, 90.1%, and 88.8% respectively, and negative predictive values were 17.7%, 19.6, and 21.9% respectively. To diagnose CAD based on all three groups of angina symptom complex, the sensitivity was 56.3%, specificity was 62.9%, positive predictive value was 90.0%, and negative predictive value was 19.5%.


CONCLUSIONS
For detecting CAD based on one, two or three groups of angina symptom complex, there are not significant differences in the diagnostic sensitivity and specificity, however, the positive predictive value is greater and the negative predictive value is smaller in the patients with renal stenosis compared with those without renal stenosis.
Fan
Zhong-Jie
ZJ
Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Yan
Jian-Hua
JH
Chen
Hong-Yan
HY
Li
Quan
Q
Fang
Quan
Q
Zhang
Shu-Yang
SY
Shen
Zhu-Jun
ZJ
Wang
Chong-Hui
CH
Jin
Xiao-Feng
XF
Zeng
Yong
Y
Liu
Zhen-Yu
ZY
Xie
Hong-Zhi
HZ
Li
Hong-Wu
HW
Liu
Yong-Tai
YT
D000368:Aged; D000787:Angina Pectoris / Q000150:complications* / Q000175:diagnosis; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000150:complications* / Q000503:physiopathology; D014567:Urography