[The natural course of coronary heart disease]

For a critical evaluation regarding surgical therapy of coronary heart disease, we quote from important publications to the following points: Early mortality due to surgical treatment, by estimating the severity of the disease as determinated by the criterions of the New York Heart Association, or by the number of the diseased coronary vessels, or by important parameters of the function of the left ventricle (0% to 12%). Frequency of acute myocardial infarction, intra-or postoperatively (10% to 15% of the survivers, 50% of the lethal cases). Frequency of occlusion, of an aorto-coronary saphenous vein bypass (up to 30%). Amelioration of ischemic heart pain by surgical treatment (up to 90%). Prevention of the progression of coronary heart disease (not proved). Natural history of patients with coronary heart disease without surgical treatment, by estimating the number of the diseased vessels (2% for one-, 6% for two-, and 10% for three vessel diseases; 30% mortality rate due to stenosis of the left main coronary artery). Comparison of the mortality rates of surgically treated patients against those without surgery for coronary heart disease with equal severity (no difference). We investigated the connection between the severity of coronary heart disease (determinated by coronary angiography), and the mortality rate in our own patient material. A fundamental conformity appeared, with the results as quoted in the literature. Finally we difined the indications for surgical treatment of coronary heart disease due to angina pectoris, which cannot be managed conservatively and which makes a normal live difficult or impossible. Moreover, the function of the left ventricle should be fairly good. An absolute indication is a stenosis of the left main coronary artery.