Prognosis in coronary artery disease. Angiographic, hemodynamic, and clinical factors.

Burggraf, Gary W.; Parker, J. O.

doi:10.1161/01.cir.51.1.146

Cited by 315 publications

(55 citation statements)

References 14 publications

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“…The survival rate was about 76% for those with double-artery disease (n = 27) and about 45% for those with triple-artery disease (n = 41). Only 10 of 14 22 The flattening near the end of the 15 year survival curve for patients with triple-artery disease may mean that the 25 patients who were not operated on and who survived to enter the third 5 year period had disease that was nonprogressive or only slowly progressive. In general, prognosis correlated better with the number of arteries severely obstructed than with the severity of narrowing.…”

Section: Discussionmentioning

confidence: 99%

Fifteen year survival study of patients with obstructive coronary artery disease.

Proudfit¹,

Bruschke²,

Macmillan³

et al. 1983

Circulation

108

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Survival rates were determined for a group of 598 patients in whom severe coronary disease was demonstrated by arteriography; initially they were treated medically and were followed-up for 15 years. Deaths due to noncoronary causes were uncommon (5% of total) in the first 5 year period but were frequent (36%) in the third period. Survival No. 5, 986-997, 1983. BECAUSE OF PROBLEMS in the study of the natural history of coronary disease, many of which are insurmountable, no completely satisfactory investigation of survival is possible. The present objective is to update studies in a large group of patients proved to have severe coronary disease by arteriography and to examine the association between clinical and invasively obtained variables and survival. MethodsThe methods and terms used in the study have been described. 1-3 At 15 year follow-up, three of 601 patients who had severe coronary disease were excluded from the series on the basis of the original criteria for selection: two were found to have had poudrage operations less than 1 year after catheterization, and one had had a Vineberg operation at 3 years. One of the three had single-artery disease, and two had involvement of two arteries; two had functional class II angina, and the other had experienced prolonged attacks of pain. Two additional patients had had bypass operations at 85 and 88 months, so these were considered dropouts at those dates instead of 10 year survivors. Fifteen year follow-up was obtained in all of the remaining 598 patients except for one, a criminal who was incarcerated at the time of the previous follow-up. Cardiac survival rates have been reported, although total survival rates (all deaths counted) were studied for some subsets.' Total survival is used in the present study, with a few exceptions specifically noted. Patients were considered dropouts for actuarial survival studies at the middle of the year in which coronary operation occurred. For cardiac survival, deaths due to noncardiac causes were considered dropouts in the year of occurrence. Survival rates were calculated by the actuarial method.5 6 Equality of survival curves was tested by a nonparametric rank test, the Breslow statistic.' Multivariate statistical analyses used the Cox proportional hazards model, permitting a stepwise selection of covariates significantly associated with survival; at each step the removal criterion was p > .15, and the entry criterion was p < .10.8 9 The test statistic was adjusted for variables that had already been entered in the model. Details of statistical methods will be supplied on request.Sixty of the original 598 patients had operations for coronary disease during the period of the study. ResultsDuring the first 5 years, 95% of all deaths were due to coronary disease, but the percentages were 84% and

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Section: Discussionmentioning

confidence: 99%

Fifteen year survival study of patients with obstructive coronary artery disease.

Proudfit¹,

Bruschke²,

Macmillan³

et al. 1983

Circulation

108

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“…17 Less is known about the second aspect of atherosclerosis severity-the prognostic significance of a stenosis. We know that the number of major coronary branches that are significantly narrowed strongly influences prognosis, 18 and that a stenosis of the left main coronary artery is much more dangerous than comparable lesions in other major branches. 19 Thus, predictably, the amount of myocardium in jeopardy distal to ath- The abscissa is the absolute diameter of the lumen at the point of greatest narrowing and (in parenthesis) the corresponding % reduction from the normal diameter.…”

Section: Subjective Interpretation Of the Arteriogrammentioning

confidence: 99%

Arteriographic assessment of coronary atherosclerosis. Review of current methods, their limitations, and clinical applications.

Brown¹,

Bolson²,

Dodge³

1982

Arteriosclerosis

136

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Coronary arteriography is presently the definitive procedure for characterizing the location and severity of coronary atherosclerosis; and despite certain reported limitations, we believe that the properly performed coronary arteriogram provides a true picture of the arterial lumen in life. Yet this widely-used clinical tool is currently limited by imprecise and, to a certain extent, inappropriate subjective methods of interpretation. More objective methods for analysis of the arteriographic information content have been described. These include caliper- and vernier- based systems for measuring relative arterial narrowing, computer-assisted methods for making accurate measurements of absolute stenosis dimensions, and photodensitometric methods for extracting three-dimensional information from a planar image of the stenosis. The availability of these objective techniques has resulted in a considerable increase in our understanding of pathogenic mechanisms in coronary disease. Advances include an expanded understanding of the mechanisms of action of nitroglycerin and verapamil and of the coronary artery constriction induced by drugs of isometric stress. Stenosis measurements have served as the basis for evaluation of certain noninvasive techniques used to detect coronary disease. An analytical approach has been developed to characterize the progression (and regression) of coronary disease from serial arteriograms. We believe clinical investigations based on these techniques hold considerable promise for further advances in the understanding of human coronary pathophysiology.

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“…'13 There is a lack of similar studies involving this measurement in unoperated patients with coronary disease, despite many reports dealing with the prognostic significance of various clinical and angiographic features. [4][5][6][7][8][9][10][11][12] Therefore, the purpose of the present study was to compare the short-term prognostic value of the systolic ejection fraction with that of some other commonly used indices -extent of vessel involvement, cardiac index, left ventricular end-diastolic pressure (LVEDP) and the resting ECG -in a group of patients with coronary artery disease receiving only medical treatment.…”

Section: The Systolic Ejection Fraction Whichmentioning

confidence: 99%

Prognosis in medically-treated coronary artery disease: influence of ejection fraction compared to other parameters.

Nelson¹,

Cohn²,

Gorlin³

1975

Circulation

201

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The prognostic value of the left ventricular ejection fraction(EF) was compared to that of other commonly used indices--severity of coronary artery disease, left ventricular end-diastolic pressure, cardiac index, and abnormal ECG--in 144 patients with coronary artery disease followed for an average of 14 months on medical management. During this period, 14 patients (10%) died. Analysis of the mortality demonstrated that the EF was the most powerful predictor of short-term survival. Thus, patients with three-vessel coronary artery disease and anormal EF (greater than 0.50) had a significantly lower mortality (12%) than did patients with three-vessel CAD and a reduced EF (33%, P less than 0.001). Similar comparisons were observed within the subgroups with abnormal hemodynamics or an abnormal ECG. Therefore, the EF appears to be an important prognostic guide in the medical therapy of coronary artery disease, and is of significantly more discriminant value than other measurements when combined abnormalities exist.

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Prognosis in coronary artery disease. Angiographic, hemodynamic, and clinical factors.

Cited by 315 publications

References 14 publications

Fifteen year survival study of patients with obstructive coronary artery disease.

Fifteen year survival study of patients with obstructive coronary artery disease.

Arteriographic assessment of coronary atherosclerosis. Review of current methods, their limitations, and clinical applications.

Prognosis in medically-treated coronary artery disease: influence of ejection fraction compared to other parameters.

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