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Long-term outcome in single-vessel coronary artery disease in Japanese patients
S Nishiyama1, H Imamura, T Iwase
1Cardiovascular Center, Toranomon Hospital, Tokyo, Japan.
Insights
Medical therapy for single-vessel disease (SVD) shows excellent long-term survival rates, comparable to healthy individuals. Cardiac events are infrequent, highlighting good prognosis for most SVD patients.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Single-vessel disease (SVD) is a common manifestation of coronary artery disease.
- Long-term outcomes of medical therapy for SVD require continued investigation.
Purpose of the Study:
- To evaluate the long-term prognosis of patients with significant single-vessel coronary stenosis treated medically.
- To compare survival rates of SVD patients with age-matched healthy controls.
Main Methods:
- Retrospective analysis of 453 patients with significant SVD (≥75% stenosis) undergoing coronary angiography between 1973-1984.
- Mean follow-up of 9.8 years, assessing survival, cardiac death, and non-fatal myocardial infarction.
- Comparison of survival based on prior myocardial infarction, affected coronary artery, and lesion location in the left anterior descending artery (LAD).
Main Results:
- 5- and 10-year survival rates were 96.0% and 91.3%, respectively, comparable to healthy controls.
- Cardiac death occurred in 7.7% and non-fatal myocardial infarction in 3.8% of patients.
- Annual incidence of cardiac events (death or MI) was 1.2% per year.
- Survival rates showed no significant differences based on myocardial infarction history, artery type, or LAD lesion location.
Conclusions:
- Medical therapy for single-vessel disease offers a favorable long-term prognosis with high survival rates.
- Patients with reduced left ventricular function (ejection fraction ≤40%) represent an exception with potentially poorer outcomes.
- These findings aid in therapeutic decision-making for SVD patients.
Abstract:
We assessed the long-term outcome of medical therapy in 453 patients who underwent coronary angiography in the period from September 1973 to February 1984, and who had a significant stenotic lesion (75% or more stenosis) in a single coronary artery. The mean follow-up period was 9.8 years. The 5- and 10-year survival rates were, respectively, 96.0% and 91.3% in these patients, and these survival rates were comparable to the cumulative survival rates in the age-matched healthy male controls determined on the basis of overall death. Cardiac death occurred in 35/453 patients (7.7%) with single-vessel disease (SVD), and non-fatal myocardial infarction occurred in 17 patients (3.8%) during the follow-up period. The incidence of cardiac events, which was defined as cardiac death and nonfatal myocardial infarction, was as low as 1.2% per year. The survival rates were compared in terms of the presence or absence of myocardial infarction, the type of the coronary artery with stenosis, and proximal versus distal location of the stenotic lesion in the left anterior descending artery (LAD). The survival rates were similarly high in both assessed groups, with no significant differences. Patients with SVD treated medically had a good prognosis, except for those patients with decreased left ventricular function (ejection fraction < or = 40%). These factors should be taken into consideration when selecting therapies for patients with SVD.