Selective Coronary Arteriography in Young Men A Follow-Up of 449 Patients

Abstract

The prognosis for 449 young men with normal, mildly abnormal, and obstructive arteriograms with and without internal mammary artery implants was studied. Prognosis for patients with normal arteriograms was good in regard to incidence of infarction and mortality. In 30 patients with mildly abnormal arteriograms there appeared to be a relatively higher incidence of myocardial infarction, although the total number of patients in this category was small. with hypertension were included. The objective was to have at least a 5-year follow-up for each patient. Clinical records were examined and clinical data were coded for Hollerith cards without reference to catheterization findings. Analysis was done manually. The following classification was used:(1) normal: smooth vessels showing no variations in lumen diameter; (2) mildly abnormal: barely perceptible to less than 50% narrowing of lumen diameter; (3) obstructive: narrowing of lumen diameter between 50% and 100% with further subdivision to: (a) 50% to almost 90%; (b) 90% to almost 100%; (c) 100%. In the latter group more than one third of the patients (36%) had undergone myocardial revascularization. Follow-up information was obtained primarily from answers to questionnaires sent to the referring physicians. When information was not received, the patients were contacted. Relatives or employers of patients, credit bureaus, and the Bureau of Vital Statistics provided data otherwise unavailable. Information obtained included the incidence of morbidity (angina, myocardial infarction) and mortality (dates and causes of deaths).Survival curves of these patients were constructed by using actuarial methods.3 Date of catheterization was used as zero point in time. Definition of clinical diagnoses were those previously used.'Briefly stated, angina pectoris was considered to be distress somewhere in the upper half of the body which was precipitated by walking and relieved promptly (within 15 minutes) by rest. Myocardial infarction was diagnosed only on the basis of electrocardiographic demonstration of characteristically absent R waves or wide deep Q waves regardless of the presence or absence of a history suggestive of the condition.

Coronary Angiography and Pathogenesis of Coronary Artery Disease in Young Male Survivors of Myocardial Infarction

“…These factors are obviously of great clinical and prognostic importance (9,10,14,21). However, in the search for etiologic and pathogenetic mechanisms, it appears to be more useful to make a distinction between coronary artery stenosis or occlusion, on the one hand, and coronary artery atheromatosis on the other.…”