Prognosis in coronary artery disease

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The influence of angiographic and hemodynamic features on survival was examined in 259 patients with significant coronary artery disease studied between 1964 and 1970. The follow-up period averaged 72 months and varied between 1 and 158 months. These patients had no revascularization surgery. The seven patients with main left coronary disease were excluded, leaving 252 patients for follow-up analysis.

The survival for the entire group at 5 years was 75% and at 10 years 59%. When these patients were considered according to the severity of coronary arteriographic abnormalities, the survival at 5 and 10 years for single-vessel disease was 91% and 71%, double-vessel disease 70% and 59%, and triple-vessel disease 55% and 40%.

The role of ventricular function was also examined in these patients by assessing the influence of heart failure, hemodynamic findings, and left ventriculographic findings on long-term survival. Patients with controlled cardiac failure at the time of the initial study fared poorly with the 5- and 10-year survival being only 34% and 22%. This contrasted with 76% and 64% in patients without cardiac decompensation. The presence of elevated resting left ventricular end-diastolic pressure (LVEDP > 12 mm Hg) was associated with a 5- and 10-year survival of 52% and 30%; patients with normal LVEDP showed 86% and 78% survival at these times. Patients with normal left ventriculograms had a 5-and 10-year survival of 91% and 74%; abnormal left ventriculograms were associated with a 62% and 49% survival.

The combined influence of the extent of arteriographic severity and ventriculographic . . .



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