Natural history of coronary artery disease proved by coronary arteriography

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Since coronary arteriography represents the most accurate diagnostic parameter in the evaluation of coronary artery disease, it is only logical that we should try to determine the value of angiographic data in studying the natural history of coronary artery disease.

Basically two major approaches are possible. First, the clinical evolution (in particular survival) can be studied in relation to angiographic data using the date of catheterization as the zero time. Preferably, such studies should be multifactorial, including all available data that may be of prognostic value. Second, we can study the anatomical evolution of coronary artery angiography two or more times. As “natural history” is usually defined as the history without surgical intervention, patients who have undergone coronary surgery should be excluded from these studies.

We review the major findings of two studies using survival after coronary arteriography and anatomical evolution as demonstrated by sequential angiographic analyses as the primary focus of interest.

The first reported study, concerns a 10-year follow-up of 601 patients studied at the Cleveland Clinic.1 Patients having obstructions of a single major coronary artery had a high survival rate for the first 4 years (2.4% cardiac mortality per year), but a less favorable prognosis afterwards (5.2% mortality per year). Survival was higher in patients with obstruction of the right coronary artery than in those with obstruction of either the circumflex or left anterior descending artery.

Ten-year survival in patients having obstructions of two or three arteries was 45.4% and 23.6%, respectively. Survival of patients having obstruction . . .



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