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Title: Uncovering the meaning of the Canadian Cardiovascular Society classification in patients with stable angina
Authors: DOURADO, Luciana O. C.POPPI, Nilson T.BITTENCOURT, Marcio S.PEREIRA, Alexandre C.CESAR, Luiz Antonio M.GOWDAK, Luis Henrique
Citation: CIRCULATION, v.125, n.19, p.E773-E773, 2012
Abstract: Introduction: Angina is the hallmark of coronary artery disease (CAD). More than 30 years ago, the Canadian Cardiovascular Society (CCS) proposed a classification regarding the functional impairment imposed by angina pectoris. There is, however, a major caveat with that classification that might lead to an underestimation of the extension of CAD: either patients (pt) become self-limited as a strategy to avoid exertional pain or they very often depend on the use of nitrates to tolerate different levels of exercise. Objectives: To determine the relationship between CCS classification and the frequency of angina attacks and the consumption of sublingual, short-acting nitrates tablets. Methods: 72 pt (60 men,59±13 years) with stable angina due to CAD were included. All pt had to fulfill an angina diary during a 4-week period, in which they recorded the number of daily episodes of angina and the number of short-acting nitrates taken. Investigators also recorded the functional class according to the CCS classification (I to IV). Continuous data were expressed as mean SD and ordinal variables, as percentage. Spearman’s rank correlation coefficient was applied to determine correlation between variables. Results: The distribution (n, %) of pt according to the CCS was CCS I (9, 12.5%), CCS II (41, 57%), CCS III (7, 9.5%), and CCS IV (15, 21%). The mean number of angina attacks per week and the mean number of sublingual nitrates tablets taken per week were, respectively,3.0±3.0 and 1.2±1.4 (CCS I), 2.7±3.6 and 1.5±1.9 (CCS II), 7.8±4.6 and 1.6±2.3 (CCSIII), and 5.5±3.7 and 2.1±3.3 (CCS IV). We found a strong, positive association between angina episodes and sublingual nitrates tablets per week (r=0.511; P<0.0001), a positive association between CCS and angina episodes per week (r=0.34; P=0.003), but no association between CCS and sublingual nitrates tablets per week (r=0.103; P=0.38).Conclusion: The CCS functional classification is a valid tool to predict the intensity of exercise level that evokes angina. However, it fails in estimating the frequency of the angina attacks. So, the true impairment in quality of life in patients with CAD (which depends not only on exercise tolerance [intensity] but also on angina frequency) may be underestimated by the CCS classification. More likely, pt may avoid certain activities previously known to them to provoke angina or use short-acting nitrates before angina actually occurs. This information must be carefully obtained by a detailed medical history.
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Comunicações em Eventos - FM/MCP
Departamento de Cardio-Pneumologia - FM/MCP

Comunicações em Eventos - HC/InCor
Instituto do Coração - HC/InCor

Comunicações em Eventos - LIM/13
LIM/13 - Laboratório de Genética e Cardiologia Molecular

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