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Progression and regression of coronary artery disease in postinfarction patients less than 40 years of age

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Abstract

Our knowledge about progression and regression of coronary artery disease derives from repeated angiography in nonsurgical patients with clinical deterioration and repeated angiography in surgical patients.

This study reports on the course of coronary artery disease (arteriosclerosis) in a nonselected group of patients with a history of myocardial infarction before age 40. These patients underwent coronary angiography a second time 3 years or more after the first examination, independent of clinical course and symptoms.

Patients

Between January 1, 1973 and July 1, 1978, 622 patients with a history of myocardial infarction before age 40 were referred to our hospital. We believe this group to be representative of young patients with myocardial infarction for two reasons:

  1. The referring community hospitals had been asked to send all patients younger than age 40 with myocardial infarction.

  2. Coronary angiography was recommended to each patient regardless of symptoms.

Of the 622 patients referred, 122 refused to undergo angiography. Five hundred patients had a first coronary angiogram; 6.6% had normal coronary arteries or <50% luminal narrowing; 56.1% had one-vessel disease; 20.2% showed two-vessel involvement; and 17% had three-vessel disease. One hundred ninety-three patients who had the first coronary angiogram more than 3 years ago were asked to have the study repeated. Thirty-four did not respond; 27 refused a second angiogram; 13 had died; and five were excluded for medical reasons (colon cancer, hepatitis).

The remaining 114 patients underwent a second coronary angiogram an average of 3.8 years after the first, irrespective of the clinical . . .


 

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