Circulation, Vol 66, 562-568, Copyright © 1982 by American Heart Association
MB Mock, I Ringqvist, LD Fisher, KB Davis, BR Chaitman, NT Kouchoukos, GC Kaiser, E Alderman, TJ Ryan, RO Russell Jr, S Mullin, D Fray and T Killip 3d
The objective of this study was to evaluate the impact on survival of the
anatomic extent of obstructive coronary artery disease and of two measures
of left ventricular (LV) performance. This study is based on 20,088
patients without previous coronary artery bypass graft surgery who were
enrolled in the registry of the National Heart, Lung, and Blood Institute
Coronary Artery Surgery Study from 1975 to 1979. The cumulative 4-year
survival of medically managed patients was analyzed to determine the
survival of specific subsets of patients with obstructive coronary disease.
The vital status of 99.8% of the patients was known. The 4-year survival of
medically treated patients with no significant obstructive disease was 97%,
in contrast to 92%, 84% and 68% in patients with one-, two- and
three-vessel disease, respectively. The presence of left main coronary
artery disease decreased survival significantly. The 4-year survival
decreased from 70% to 60% in patients with three-vessel disease when
significant obstruction of the left main coronary artery was also present.
Patients with significant coronary artery disease who had an ejection
fraction of 50--100%, 35-- 49%, and 0--34% had a 4-year survival of 92%,
83% and 58%, respectively. The systolic contraction pattern was assessed in
five selected segments and given a score of 1--6, with a score of 1 for
normal function, increasing to 6 if an aneurysm was present. In a patient
with normal LV contraction in all five segments of the LV ventricular
angiogram, the LV score would equal 5. Patients with an LV score of 5--11,
12--16 and 17--30 had 4-year survivals of 90%, 71% and 53%, respectively.
Patients with good LV function (a score of 5--11) had a 4-year survival of
94%, 91% and 79% for one-, two- and three- vessel disease, respectively.
Patients with poor left ventricular function (score of 17--30) had a 4-year
survival rate of 67%, 61% and 42% in one-, two- and three-vessel disease,
respectively. Thus, LV function is a more important predictor of survival
than the number of diseased vessels.
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Survival of medically treated patients in the coronary artery surgery study (CASS) registry
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