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SUMMARY The clinical course was followed for 10 years in 521 patients whose coronary arteriograms did not show any severe obstruction. Coronary disease had been suspected in all patients before arteriography. Two of 357 patients thought to have normal arteriograms died from coronary disease and two of 101 patients died who had less than 30% estimated narrowing of at least one coronary artery. Ten deaths ascribed to coronary disease occurred in 63 patients who had 30-50% narrowing of at least one major coronary artery. The difference in death rates between the normal or mildly diseased groups and the group that had moderate narrowing was significant (p < 0.01). Coronary events (death from coronary disease, subsequent myocardial infarction, or arteriographic evidence of progression of coronary obstruction) occurred in 2.1% of those who had normal arteriograms, 13.8% of the group with mild lesions, and 33% of those with moderate degree of coronary arterial narrowing.A 5-YEAR MINIMUM follow-up study of 500 patients whose coronary arteriograms failed to show severe obstruction was reported.1 A high survival rate was found, especially in those who had normal coronary arteries. Because the follow-up was possibly too short for definitive conclusions, the minimum followup was extended to 10 years. If severe coronary lesions were frequently missed arteriographically during the 1964-1965 period or if mild coronary narrowing constituted the early stage of an inevitably progressive disease, a relatively low survival rate might be expected compared with that of an age-comparable group drawn from the general population. MethodsThe same cases we previously reported were followed for 10 years or until lost. The original report included 521 patients, of whom 500 were followed up diameter of a major vessel. Lesions resulting in less than 30% narrowing of a major artery were considered minor and those causing an estimated 30-50% decrease in diameter were called moderate. Patients who had clinically recognized forms of heart disease other than coronary disease were excluded. Hypertension and the history of arrhythmia were not considered grounds for exclusion. All clinical diagnoses were coded before the original follow-up was initiated and the follow-up we report was completed without knowledge of the clinical or arteriographic findings. The methods of tracing patients reported previously were used. If cardiac complications or death were reported, we attempted to secure definitive details. In some cases the patient's symptomatic status was not known because the physician or the family of the patient was not fully informed and the patient could not be contacted. In all cases we tried to determine whether the patient had angina, defined as pain in the upper half of the body precipitated by walking and relieved within 15

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.