The unnatural history of coronary artery disease
The complete clinical course of any disease—the natural history—is seldom understood. Some conditions are difficult to detect in their early stages; morbidity and mortality may span a period of time longer than the professional career of the investigator and the disease may be altered for better or worse by well intentioned therapeutic measures. These difficulties are encountered in the study of coronary artery disease. Although all obstacles cannot be surmounted, it is necessary to try.
Until the advent of selective coronary arteriography, it was not possible to be certain of the clinical diagnosis of coronary artery disease. This technique has enabled the identification of a population of symptomatic patients that has severe obstructive lesions of the coronary arteries and some asymptomatic patients. The entire spectrum of obstructive coronary artery disease is not detected, because certain types of patients are selected for study and various therapeutic measures are applied which may affect the complications of and the survival from the condition. Ideally, it would be desirable to have periodic, repetitive arteriography in an untreated group, but such a study is not in the best interest of the individual affected. Still it is helpful to record the complications and survival of patients who have been identified by single catheterization. By clearly outlining the clinical, arteriographic, and ventriculographic findings, and dividing patients into well defined subgroups, it is possible to derive a considerable amount of useful information. This has been done for a large group of medically treated patients, who have. . .