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Clinical and arteriographic variables predictive of survival in coronary artery disease
Insights
Coronary artery disease patients with severe left anterior descending artery narrowing, especially proximal to the first septal branch, face higher mortality. Simultaneous narrowing in multiple arteries and prior heart attacks also predict poor survival.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Assessing long-term outcomes for patients with severe coronary artery narrowing is crucial for understanding disease progression.
- Coronary arteriography was a key diagnostic tool for evaluating coronary artery disease severity before widespread surgical intervention.
Purpose of the Study:
- To determine survival, subsequent myocardial infarction, and anginal status in patients with significant coronary artery narrowing.
- To identify predictors of mortality in patients with severe coronary artery disease.
Main Methods:
- Retrospective analysis of 90 patients undergoing coronary arteriography between 1960-1967 with at least 70% coronary arterial narrowing.
- Follow-up data collected over a mean period of 9.9 years to assess cardiac events and survival.
- Multivariate stepwise discriminant function analysis used to identify independent predictors of mortality.
Main Results:
- 29 of 78 surgically "suitable" patients died of cardiac causes; 7 survivors had myocardial infarction.
- Significant narrowing proximal to the first septal branch of the left anterior descending artery was associated with higher mortality.
- Independent predictors of mortality included simultaneous narrowing in left anterior descending and right coronary arteries, prior myocardial infarction, and proximal left anterior descending artery narrowing.
Conclusions:
- Severe coronary artery narrowing, particularly in specific locations, poses a significant long-term risk.
- Identifying key predictors like multi-vessel disease and prior infarction aids in risk stratification for coronary artery disease patients.
Abstract:
Survival, subsequent myocardial infarction and current anginal status were determined for 90 nearly consecutive patients who underwent coronary arteriography at the Johns Hopkins Hospital between 1960 and 1967. All patients had at least one coronary arterial narrowing equal to or greater than 70 percent; 78 of 90 patients would be candidates for coronary bypass surgery by present criteria. Twenty-nine of the 78 surgically "suitable" patients died of cardiac causes; 7 of 49 survivors sustained an acute myocardial infarction (mean follow-up period 9.9 years). Patients with a 70 percent or greater narrowing proximal to the first septal branch of the left anterior descending coronary artery had a significantly greater mortality compared with patients with equivalent narrowing distal to the first septal branch or with patients without 70 percent or greater narrowing of the left anterior descending artery. The patients with a 70 percent or greater narrowing of the left anterior descending artery who died were those with a significant narrowing in at least one other major coronary artery. Multivariate stepwise discriminate function analysis of all clinical, electrocardiographic (except stress electrocardiographic) and arteriographic variables identified three independent predictors of mortality: (1) the simultaneous occurrence of a narrowing in left anterior descending and right coronary arteries, (2) prior myocardial infarction; and (3) 70 percent or greater narrowing proximal to the first anterior descending septal branch. When stress electrocardiographic findings were included, a "positive" stress electrocardiographic test was also an independent predictor of mortality.