Detecting Occult Coronary Disease in a High-Risk Asymptomatic Population

Roger S. Blumenthal, Diane M. Becker, Lisa R. Yanek, Thomas R. Aversano, Taryn F. Moy, Brian G. Kral, Lewis C. Becker
2003 Circulation  
Background-Exercise stress testing alone or with perfusion imaging is the standard screening method to determine the presence of obstructive coronary artery disease (CAD) in people with chest pain. In asymptomatic individuals with a family history of premature CAD, it is unclear whether abnormalities on these functional exercise tests represent significant coronary disease. Methods and Results-An abnormal exercise test, thallium scan, or both occurred in 153 (21%) of 734 asymptomatic siblings
more » ... persons with documented CAD, of whom 105 underwent coronary angiography with quantitative analysis of stenosis severity. Overall, 95% had coronary atherosclerosis, but only 39% had 1 or more stenoses with Ն50% narrowing. Of 30 siblings in whom the exercise test and perfusion scan were both abnormal, 70% had Ն50% stenoses. The mean stenosis in arteries that fed perfusion defects was only 43Ϯ31%, and 68% of such stenoses were Ͻ50%. However, in 71% of all defects, the location matched arteries with the most severe stenoses. Conclusions-In asymptomatic persons with a family history of CAD, abnormal exercise scintigraphy identifies predominantly mild coronary atherosclerosis. Perfusion defects may be caused by coronary vasomotor dysfunction in addition to atherosclerotic plaque. (Circulation. 2003;107:702-707.)
doi:10.1161/01.cir.0000048127.93169.88 pmid:12578872 fatcat:q6t56akt4jfbbg27psqc3b65vy