1028-61 Diagonal Earlobe Crease and Prevalence of Coronary Artery Disease: An Angiographlc Study

Abstract

There have been numerous investigations regarding the association between diagonal ear lobe crease (ELC) and the presence of coronary artery disease (CAD). Results have been mixed. We wish to report the largest angiographic study to date of this clinical entity. A total of 1273 consecutive patients who underwent angiograms were examined for the presence or absence of an ELC prior to their angiograms. Patients with previous open heart surgery, PTCA or previously documented angiographic CAD were excluded from analysis. The ELC sign was considered positive if there were a prominent wrinkle which extended for at least a third of the lobule length. Coronary angiograms were interpreted by cardiologists unaware of the patient's ELC sign. Significant CAD (SCAD) was defined as >50% luminal narrowing of left main or >70% luminal narowing in the other 3 major arteries. There were 91% intraobserver and 96% interobserver agreement for the diagnosis of the ELC sign. The chi-square test was used for statistical analyses. The study population consisted of 954 patients, mean age 60 (650 males) who underwent angiograms for their first time. Normal angiograms were noted in 129 patients; nonsignificant CAD in 142 and SCAD in 683 patients. Prevalence of ELC in patients with SCAD was 78% and in those without SCAD was 68% (p = 0.001). Sensitivity and specificity of the ELC sign was 78% and 32% respectively. The positive and negative predictive values were 74% and 60% respectively. The prevalence of ELC and SCAD increased with advancing age (p = 0.001). After stratification for age, there was no statistically significant association between Ihe ELC sign and SCAD. (1) The ELC sign has a poor positive and negative predictive values in predicting the presence of SCAD. (2) The association between the ELC sign and SCAD is likely due to confounding effect of advancing age.