Progression of coronary artery disease: Cinearteriographic and clinical observations in medically and surgically treated patients

Abstract

The evolutionary pattern of occlusive coronary artery disease was studied by comparing coronary cinearteriographic findings in repeated catheterizations of 85 patients. Fifty-six percent of 16 medically treated patients with coronary artery disease were found to have progression of occlusive coronary artery disease in the repeated study. Patients who had progressive coronary artery disease were similar to those with nonprogressive disease in age and in duration and severity of disease. A history of hypercholesterolemia seemed to be more frequent among patients with progressive than in those with nonprogressive coronary artery disease. Other risk factors of coronary artery disease were found to be similarly frequent among patients with progressive and nonprogressive disease. Progression of occlusive coronary artery disease was associated with a greater deterioration of cardiac function. Cardiac index decreased significantly in patients with progressive disease, and did not change very much in patients with nonprogressive disease. Among the patients with progressive disease, two had a myocardial infarction between catheterizations, whereas none of those with nonprogressive disease had infarction. Electrocardiographic findings were similar in both groups of patients, except for new infarction changes in the patients with progressive disease who sustained an infarct. Seventeen percent of 65 patients who underwent aortocoronary saphenous vein graft bypass surgery were found in the second study (average interval 10.1 months) to have proximal occlusion of a distally grafted vessel with a patent graft. Progression of disease in nongrafted coronary arteries was found in 6 percent of the surgically treated group. Of four patients who had internal mammary artery implantation, two had progression of coronary disease in a repeat study. Conclusions regarding the evolution and progression of coronary artery disease should be drawn only from medically treated patients, since coronary artery surgery may alter the natural course of this disease. Medically treated patients who are reconsidered for surgical treatment should have a repeat catheterization to detect any change in distribution of occlusive coronary artery disease and in cardiac function.