Clinical course of patients with normal or slightly or moderately abnormal coronary arteriograms: 10-year follow-up of 521 patients.

Abstract

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

Long-Term Prognosis of Patients with Acute Coronary Syndrome and Moderate Coronary Artery Stenosis

“…Survival rate was significantly lower for the subset of patients who suffered from moderate disease. A change in the slope of cardiac survival for this population appears at 5 years; interestingly, this finding is somewhat similar to that reported in a previous study [3]. The kinetics of progression of coronary lesions is one likely explanation.…”

“…Patients with moderate disease, defined as 30–50% narrowing in at least one coronary artery, had 10% mortality at 5 years and 25% at 10 years [3, 14, 15]. Similar results were observed in the CASS registry study, the 7- year cardiovascular death rate was 4% for the patients with normal arteriogram and 8% for those whose study revealed mild disease (p < 0.001) [13].…”

“…Our study demonstrated the independent prognostic role of moderate in-significant lesion in patients with ACS. Several studies have demonstrated that patients with angina pectoris associated with normal coronary arteries have an excellent long-term survival with a rate of MACE between 4 and 9% at 10 years after coronary angiogram, but without prognostic factor analysis [1, 2, 3, 17, 18]. However, the CASS study identified four independent predictive factors: sex, age, smoking and moderate stenosis [17].…”

“…In contrast, an increase in major cardiac events (MACE) was observed in patients with mild or moderate degree of coronary arterial narrowing compared to those with normal coronary arteries [3]. In addition, in subjects with known epicardial coronary disease, repeat coronary angiography demonstrates clinically significant progression of atherosclerosis in one quarter to one third of patients each year [4, 5].…”

Long-term (10 years) prognostic value of a normal thallium-201 myocardial exercise scintigraphy in patients with coronary artery disease documented by angiography

“…It is also useful to evaluate the prognosis of the disease, especially in cases with abnormal scintigrams. Factors indicating poor prognosis include the presence of large reversible defects, left ventricular dilatation and an increase in pulmonary uptake' 11 .…”