Long-Term Results of the Medical Treatment of Coronary Artery Disease

Abstract

The natural history of patients with ischemic heart disease varies widely depending upon the anatomic lesion and extent of left ventricular dysfunction. Several clinical variables may also be used to help determine the likelihood of long-term survival. Individuals with high-grade isolated disease of the left anterior descending coronary artery, without significant impairment of ventricular function, have little morbidity and mortality for the 2-year period after arteriography. At the other end of the spectrum, medically treated patients with stenosis of the left main coronary artery or three-vessel disease without such involvement have a reduced life expectancy compared with patients treated surgically. Global judgments on long-term results of the medical treatment of coronary artery disease are meaningless. Efforts should be made to delineate optimal treatment for various subgroups of patients under the broad rubric of ischemic heart disease.

Silent Myocardial Ischemia

“…4 It is estimated that the first manifestation of coronary artery disease (CAD) in 60-70% of patients is either sudden death or myocardial infarction, whereas only a minority present first with angina or other symptoms of reversible ischemia. 5 The reason for the onset of symptoms late in the disease process is not known but could be related to an impairment in, or inadequate fidelity of the cardiac sensory mechanism responsible for signaling myocardial ischemia. This paper will review evidence for such a reduction in cardiac sensing of ischemia, termed silent myocardial ischemia.…”

Sudden death associated with silent myocardial infarction in a 35-year-old man: a case report

“…Cardiovascular disease is the most frequent cause of death worldwide [ 1 ]. The first manifestation of coronary artery disease in 60–70 % of patients is either sudden death or myocardial infarction (MI) [ 2 ]. Silent myocardial infarction (SMI) relates to absence of symptoms usually associated with myocardial ischemia.…”

Cardiac arrest due to an unexpected acute myocardial infarction during head and neck surgery: A case report

“…The first manifestation of coronary artery disease in 60–70% of patients is sudden death or MI [ 10 ]. A retrospective study of 193 patients who underwent head and neck reconstructive surgery showed a 3.6% incidence rate of postoperative MI [ 11 ].…”