Predictive Value of Persistent Post-Recovery ST-Segment Depression for Double-Vessel Coronary Artery Disease: An Observational Prospective Cohort Study

Abstract

Objectives: To evaluate whether persistent post-recovery ST-segment depression (PPRSTD ≥4 minutes) during exercise testing (ET) predicts double-vessel coronary artery disease (2VD) and to assess its value in localizing critical coronary lesions. Methodology: This prospective cohort study enrolled 86 consecutive patients with chronic stable angina (CSA, CCS class II) undergoing ET and scheduled coronary angiography (C. Ang.) between January 2017 and February 2018. Fourteen patients were excluded based on predefined criteria, leaving 72 patients (mean age 40–60 years; 39 males, 33 females) for final analysis. Of these, 33 exhibited ≥4 minutes PPRSTD, and 39 had <4 minutes. C. Ang. findings were classified by vessel involvement (LMS, LAD, LCX, RCA), lesion site (ostial, proximal, mid), and vessel dominance. Statistical analysis included Chi-square, Fisher’s exact test, odds ratios (OR), and measures of association (Yule’s Q, Cramér’s V). Results: Patients with ≥4 minutes PPRSTD were strongly associated with double-vessel disease involving the LAD and dominant RCA, predominantly affecting proximal or ostial segments (11 vs. 0; p <0.001). Sensitivity and specificity were 63.9% and 100%, respectively, with PPV 33.3% and NPV 100%. A very strong positive correlation was observed (Yule’s Q = 0.945, Cramér’s V = 0.462). No significant association was found between ≥4 minutes PPRSTD and LMS or triple-vessel disease. Male patients were disproportionately represented in the ≥4 minutes group. Conclusion: Persistence of ≥4 minutes PPRSTD after ET is a reliable non-invasive predictor of LAD and dominant RCA double-vessel disease with proximal critical lesions. This marker provides valuable prognostic information for risk stratification and localization of CAD prior to angiography.