Related Experiment Videos
[Prognosis and clinical course in patients with advanced, inoperable coronary heart disease]
Insights
Patients with inoperable coronary heart disease showed a 5-year survival rate of 53%. Left ventricular function, not vessel disease, predicted prognosis, with many maintaining good quality of life.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Context:
- Evaluating long-term outcomes for patients with coronary heart disease (CHD) deemed ineligible for revascularization surgery.
- Assessing prognostic factors and quality of life in a cohort of 128 patients diagnosed between 1970 and 1981.
- Understanding the clinical course of "inoperable" CHD.
Purpose:
- To determine the clinical course, prognostic indicators, and quality of life in patients with coronary heart disease unsuitable for revascularization.
- To identify factors that significantly influence survival and patient well-being in this specific CHD population.
- To analyze the impact of left ventricular function versus coronary artery anatomy on patient outcomes.
Summary:
- The study followed 128 patients with coronary heart disease rejected for surgery due to poor left ventricular function or diffusely diseased coronaries.
- The 5-year survival rate was 53%, with left ventricular ejection fraction and end-diastolic pressure identified as key prognostic factors.
- Age, myocardial infarction history, and vessel count did not predict outcomes, while many patients reported continued employment and acceptable angina levels.
Impact:
- Highlights the prognostic importance of left ventricular function over coronary anatomy in inoperable CHD.
- Demonstrates that a significant proportion of patients with severe CHD can maintain a reasonable quality of life and functional capacity.
- Informs clinical decision-making and patient counseling regarding long-term management and expectations for individuals with "inoperable" coronary artery disease.
Abstract:
The clinical course, factors of prognostic significance and the quality of life in 128 patients with coronary heart disease rejected for revascularization surgery between 1970 and 1981 and followed up for 1-135 months (mean 43 months) were evaluated. The reason for rejection for bypass surgery was poor left ventricular function in 15 patients, diffusely diseased coronaries in 82 patients and both of the above in 31 patients. The actuarial 5-year survival rate in the entire population amounted to 53%, resulting in an average annual mortality rate of 9.4%. Left ventricular ejection fraction and end-diastolic pressure at rest were the only parameters of prognostic significance. Neither age, history of myocardial infarction, physical working capacity nor the number of diseased vessels were of prognostic value. Despite having "inoperable" coronary artery disease, many patients were able to continue gainful employment (61%) and were not severely restricted by angina (50% NYHC I-II).