Natural history of severe proximal coronary artery disease as documented by coronary cineangiography

Abstract

Studying the natural history of patients with severe proximal coronary arterial lesions may assist evaluation of coronary revascularization surgery. We reviewed the mortality statistics of 469 patients with 80 to 100 percent occlusive lesions in the proximal coronary tree as diagnosed by selective angiography. Only patients with normal or moderately impaired left ventricular function were included in the study; patients with severe cardiomegaly, congestive heart failure or severe left ventricular impairment by left ventriculography were excluded. Follow-up periods ranged from 6 to 11 years for 178 patients with single vessel disease, 177 with double vessel disease and 114 with triple vessel disease. Patients with isolated disease of the left anterior descending artery had a 4 percent average yearly attrition rate or a 6 year mortality rate of 25.5 percent (17 of 69). Those with isolated disease of the right coronary artery demonstrated only a 2.3 percent yearly attrition rate or a 14 percent mortality rate in 6 years (11 of 77). Patients with double and triple vessel disease had, respectively, 41.5 and 63 percent 6 year mortality rates. Survival was related to the number of vessels involved. Patients with single vessel disease of the left anterior descending artery had a significant annual mortality rate. The prognosis improved when good angiographic collateralization was present, particularly in single vessel disease with total occlusion. Functional disability, classified according to the New York Heart Association criteria, was related to mortality rates and proved a useful indicator in large patient groups. Prior myocardial infarction, location of the lesion above or below the major septal perforator in left anterior descending artery disease, and left main trunk lesions did not alter the prognosis significantly.