The anatomic evolution of coronary artery disease demonstrated by coronary arteriography in 256 nonoperated patients.

Abstract

SUMMARY Coronary arteriography was performed twice in 256 nonoperated patients, including 92 surgical candidates who were recatheterized because of the long wait for surgery. Criteria to define progression and regression were established in advance. Analysis of separate segments, reflecting separate lesions, revealed that progression percentages increased proportionally with the degree of initial narrowing and the Interval between atheterizations, ranging from 1.2% to more than 20%. The highest progression percentages were shown by the proximal right coronary artery, the left anterior descending artery distal to the first septal and first diagonal branches, and the obtuse marginal branch of the circumflex artery. In 56.3% of the patients, progression was found in at least one segment, ranging from 40% in patients who were recatheterized within 1 year to 92%'in patients who were recatheterized after 5 years or longer (p < 0.025). In 12 patients (4.7%), regression had occurred; in two cases obstructions had reverted to less than 50% narrowing. Regression was associated with progression in other branches in three cases. Indications for recatheterization did not correlate significantly with progression, but a higher progression percentage was found in patients who had sustained a myocardial infarction during follow-up than in those who had not (p < 0.05). Comparison of potential surgical procedures based on the first and second angiogram revealed that at the second catheterization more distal anastomoses were required to achieve complete revascularization in 29.3% of the patients and that left ventricular contractions had deteriorated markedly in 15.6%. These fractions correlated with the duration of the Interval between catheterizations.REPEATED arteriographic visualizations of the coronary circulation in patients with coronary atherosclerosis permit study of the anatomic evolution of the disease during life. As surgical revascularization may have an additional unknown influence on the disease process, data should be obtained primarily on nonoperated patients. However, the majority of patients who are considered surgical candidates are operated on soon after catheterization, so only a small and selected group of nonoperated patients is available for follow-up; in these patients, it is difficult to justify recatheterization on a routine basis. Therefore, the few studies on this subject have mostly dealt with patients selected for specific reasons.'-1In the Netherlands, the number of angiographic facilities has surpassed the expansion of the surgical capacity, leading to long waits for coronary surgery. This has particularly concerned patients in stable or improving clinical condition who were felt to be in no immediate jeopardy. In this study we analyzed the evolution of coronary lesions in 256 patients who had significant coronary artery disease and in whom arteriography had been performed two times. In particular, we studied the anatomic patterns of progression and regression and attempt to assess its implications...

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