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[Mortality of subjects with coronary insufficiency with severe, tritruncal and diffuse arterial lesions]
Insights
This study on severe coronary artery disease found a 36% 5-year mortality. Myocardial dysfunction and prolonged angina significantly increased survival risks in patients ineligible for bypass surgery.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Diffuse, severe triple-vessel coronary artery disease poses significant survival challenges.
- Patients ineligible for aortocoronary bypass surgery represent a high-risk cohort.
- Understanding prognostic factors is crucial for managing advanced coronary artery disease.
Purpose of the Study:
- To analyze survival rates in patients with severe coronary artery disease unsuitable for bypass surgery.
- To identify key clinical predictors of mortality in this specific patient group.
- To evaluate the impact of myocardial dysfunction on long-term outcomes.
Main Methods:
- Survival analysis (direct and actuarial) of 151 patients with severe triple-vessel coronary artery disease.
- Exclusion of patients with left main stem disease and non-cardiac deaths for subgroup analysis.
- Assessment of clinical, radiological, and electrocardiographic parameters, including ejection fraction.
Main Results:
- Global mortality was 36% at 5 years and 53% at 8 years.
- Annual mortality was 7% after excluding non-cardiac deaths, and 6% excluding left main stem disease.
- Myocardial dysfunction indicators (e.g., cardiac failure, reduced ejection fraction) were significant predictors of mortality.
- History of angina exceeding 3 years was associated with significantly higher mortality.
Conclusions:
- Survival is significantly limited in patients with severe coronary artery disease ineligible for bypass.
- Myocardial dysfunction and prolonged angina are critical determinants of prognosis.
- Early identification of these factors is essential for risk stratification and management.
Abstract:
The cases of 151 patients with diffuse, severe, triple coronary vessel disease excluding any possibility of aortocoronary bypass surgery with a Ross and Friesinger index of over 10/15 were analysed for survival by direct methods up to 5 years and by actuarial methods up to 8 years. The global mortality rate was 36% at 5 years and 53% at 8 years. Excluding 10 non-cardiac deaths, the annual mortality rate was 7%. When the 9 cases of left main stem disease, responsible for 6 deaths in 5 years (annual mortality of 13%) were excluded, the annual mortality of the remaining 132 cases was 6% per year. The actual degree of arterial stenosis did not significantly affect the outcome in these patients selected by the severity of their coronary lesions. Mortality was significantly higher when there was a history of angina of over 3 years duration. All clinical, radiological and electrocardiographic parameters indicating myocardial dysfunction (cardiac failure, radiological cardiomegaly, intraventricular conduction defects, left ventricular hypertrophy) had a decisive influence on mortality. A decreased ejection fraction was a poor prognosis factor associated with a 2.5% increase in the annual mortality rate for each 10% decrease of ejection fraction under 50%. Although no differences were found irrespective of whether coronary angiography was performed in an acute context (during a preinfarction syndrome), most of the survival graphs showed a clearcut increase in the downward slope during the first 6 months, indicating a mortality rate four to eight times higher than during later periods.