Progress study of 590 consecutive nonsurgical cases of coronary disease followed 5-9 years. II. Ventriculographic and other correlations.

SUMMARY The clinical progress was studied in a series of 590 consecutive nonsurgical patients with coronary disease documented by selective coronary arteriography. All had 50% or more obstruction in at least one major artery. Patients who were operated on within 5 years were excluded. Observations of the survivors ranged from 5 to 9 years. During the total observation period 263 patients died; only 19 deaths were not due to coronary disease. The 5-year cardiac mortality rate was 34.4% for the entire population, 14.6% for patients with one-vessel involvement, 37.8% for patients with two-vessel involvement, 53.8% for patients with three-vessel involvement , and 56.8% for those with at least 50% narrowing of the left main coronary artery. In patients with single-vessel disease the presence or absence of additional lesions causing less than 50% narrowing was of significant prognostic influence. T HE EVALUATION of the prognostic significance of obstructions found at coronary arteriography has become difficult because of present day surgical interruption of the natural course. Prospective studies, to be meaningful, would require that a large number of patients with various degrees of angina pectoris would deliberately be deprived of the symptomatic relief obtainable by operation, and would not be given the benefit of a probable improvement of prognosis with regard to mortality and myocardial infarction. Therefore, at present, data on the natural history of coronary disease have to be collected primarily by retrospective studies, in spite of the inherent limitations. The present study deals with a series of 590 patients with coronary disease who were studied by selective coronary arteriographyl when surgery was still restricted to a minority, the single implantation of an internal mammary artery being the only operation available at the time. The latter operation was restricted to those patients having severe proximal obstruction of the anterior descending artery in the presence of a well functioning myocardium in the area supplied by that vessel. None was treated surgically within 5 years after coronary arteriography. Primarily the predictive information contained in coronary arteriograms and left ventricular angiograms was analyzed. The prognostic significance of other clinical factors was studied and the relationship of these to arterio-graphic and ventriculographic findings was investigated. Selection of Patients and Methods Patients who were studied by selective coronary arteriography from January 1963 through July 1965 were selected for this study. Almost all patients had been referred because of chest pain but in a small minority congestive …