Circulation, Vol 63, 527-536, Copyright © 1981 by American Heart Association
AV Bruschke, TS Wijers, W Kolsters and J Landmann
Coronary arteriography was performed twice in 256 nonoperated patients,
including 92 surgical candidates who were recatheterized because of the
long wait for surgery. Criteria to define progression and regression were
established in advance. Analysis of separate segments, reflecting separate
lesions, revealed that progression percentages increased proportionally
with the degree of initial narrowing and the interval between
catherizations, ranging from 1.2% to more than 20%. The highest progression
percentages were shown by the proximal right coronary artery, the left
anterior descending artery distal to the first septal and first diagonal
branches, and the obtuse marginal branch of the circumflex artery. In 56.3%
of the patients, progression was found in at least one segment, ranging
from 40% in patients who were recatheterized within 1 year to 92% in
patients who were recatheterized after 5 years or longer (p less than
0.025). In 12 patients (4.7%), regression had occurred; in two cases
obstructions had reverted to less than 50% narrowing. Regression was
associated with progression in other branches in three cases. Indications
for recatheterization did not correlate significantly with progression, but
a higher progression percentage was found in patients who had sustained a
myocardial infarction during follow-up than in those who had not (p less
than 0.05). Comparison of potential surgical procedures based on the first
and second angiogram revealed that at the second catheterization more
distal anastomoses were required to achieve complete revascularization in
29.3% of the patients and that left ventricular contractions had
deteriorated markedly in 15.6%. These fractions correlated with the
duration of the interval between catheterizations.
ARTICLES
The anatomic evolution of coronary artery disease demonstrated by coronary arteriography in 256 nonoperated patients
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