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Changes in sequential coronary arteriograms and subsequent coronary events. Surgical Control of the Hyperlipidemias

H Buchwald1, J P Matts, L L Fitch

  • 1Department of Surgery, University of Minnesota, Minneapolis 55455.

JAMA
|September 16, 1992
PubMed

Insights

Sequential coronary arteriogram changes predict clinical events, offering a prognostic indicator for overall and atherosclerotic coronary heart disease mortality in patients. This aids in atherosclerosis intervention trials.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Interventional Cardiology

Background:

  • Atherosclerosis intervention trials require reliable outcome measures.
  • Sequential coronary arteriograms offer detailed insights into disease progression.

Purpose of the Study:

  • To assess the relationship between changes in sequential coronary arteriograms and subsequent clinical coronary events.
  • To determine if arteriographic changes can serve as surrogate endpoints in atherosclerosis trials.

Main Methods:

  • A randomized trial (Program on the Surgical Control of the Hyperlipidemias) involving 838 patients.
  • Coronary arteriograms were obtained at baseline, 3, 5, and 7/10 years.
  • Blinded assessment of arteriographic changes and correlation with clinical events.

Main Results:

  • Changes in coronary arteriography significantly predicted overall and atherosclerotic coronary heart disease mortality.
  • A strong association was found between arteriographic changes and combined endpoints of mortality or myocardial infarction in both control and surgical groups.
  • Stratified analysis revealed significant differences in clinical events based on disease progression.

Conclusions:

  • Coronary arteriographic changes are a valid surrogate endpoint for specific clinical events in atherosclerosis trials.
  • Arteriographic assessments provide statistically compelling evidence for predicting mortality.
  • Changes in coronary atherosclerosis severity serve as prognostic indicators for individual patients.
Abstract

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