The angiographic prevalence, clinical predictors, and sensitivity and specificity of a bilateral arm blood pressure differential for predicting proximal left subclavian artery stenosis were established in 492 patients undergoing cardiac catheterization. Seventeen subjects (3.5%) in the overall population and nine subjects (5.3%) with potential surgical coronary disease had proximal left subclavian stenosis. Precatheterization evidence of peripheral vascular disease (PVD) was the only predictor of subclavian stenosis in the overall population (P < 0.001; OR = 7.9; 95% CI = 2.6-24.3) and in patients with potential surgical coronary disease (P = 0.04; OR = 5.4; 95% CI = 1.1-27.2). Both a bilateral blood pressure differential of > 10 mm Hg and of > or =20 mm Hg had a good specificity but a poor sensitivity for predicting left subclavian stenosis. Thus, left subclavian angiography should be performed in patients with surgical coronary disease with either an arm blood pressure differential of > 10 mm Hg or with other precatheterization evidence of PVD. Cathet Cardiovasc Intervent 2001;54:8-11.
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