Prognosis of Coronary Heart Disease Progression of Coronary Arteriosclerosis: International Symposium Held in Bad Krozingen October 22–23, 1982

257 Pages·1983·14.38 MB·English

by  W. Steinbrunn

Prognosis of Coronary
Heart Disease
Progression of
Coronary Arteriosclerosis
International Symposium
Held in Bad Krozingen
October 22-23, 1982
Edited by H. Roskamm
With 94 Figures and 80 Tables
Springer-Verlag
Berlin Heidelberg New York Tokyo 1983
Professor Dr. H. Roskamm
Benedikt Kreutz Rehabilitationszentrum
fUr Herz- und Kreislaufkranke Bad Krozingen e. V.
Siidring 15, 7812 Bad Krozingen
ISBN-13: 978-3-642-69054-9 e-ISBN-13 :978-3-642-69052-5
DOl: 10.1007/978-3-642-69052-5
Library of Congress Cataloging in Publication Data. Main entry under title:
Prognosis of coronary heart disease - progression of coronary arteriosclerosis. Biblio
graphy: p. Includes index. 1. Coronary heart disease - Prognosis. I. Roskamm,
H. (Helmut), 1933-. [DNLM: 1. Coronary disease. WG 300 P964]
RC685.C6P741983 616.1'23075 83-14662
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Preface
The papers presented in this book were held at the International Sym
posium on "Prognosis of Coronary Heart Disease - Progression of Cor
onary Arteriosclerosis" on October 22 and 23, 1982 in Bad Krozingen,
FRG on the occasion of the 10th anniversary of the Rehabilitationszen
trum Bad Krozingen.
The symposium was sponsored and supported by the European So
ciety of Cardiology and the Pharma Schwarz Co. The scientific com
mittee was composed of F. Loogen (Dusseldorf), P. G. Hugenholtz
(Rotterdam), and the editor of this book.
To all of these and to my co-workers many thanks.
Bad Krozingen, August 1983 H. Roskamm
Table of Contents
W. Steinbrunn and P. R. Lichtlen
Prognosis of Patients with Coronary Heart Disease Evaluated Using Data
Obtained by Invasive Methods ........................ 1
R.A. Bruce
Prognosis of Coronary Heart Disease Patients Evaluated by Data
Obtained by Noninvasive Methods . . . . . . . . . . . . . . . . . . 16
K. Bachmann, W. Niederer, H. Fuchs, and H. Holzberger
Prognosis of Coronary Heart Disease Patients Evaluated by Data
Obtained by Invasive and Noninvasive Methods .............. 24
R. Balcon, M. Cattell, and K. Wong
Prognosis of Coronary Heart Disease Patients Evaluated by Data
Obtained by Angiography and Exercise Testing . . . . . . . . . . . 36
M. Kaltenbach and W.-D. Bussmann
Prognostic Relevance of Findings from Invasive and Noninvasive
Investigations in Coronary Heart Disease Patients ............. 44
H. Gohlke, L. Samek, P. Betz, and H. Roskamm
Prognostic Relevance of Invasive and Noninvasive Data in
Angiographically Defined Subgroups of Coronary Heart Disease
Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 54
v. F. Froelicher
Angiographic Findings and Prognosis in Asymptomatic Men with Rest
and Exercise Electrocardiographic Abnormalities . . . . . . . . . . . . .. 67
J. S. Borer, J. Wallis, J. Holmes, H. L. Goldberg, J. W. Moses,
and J. Fisher
Prognostication in the Patient with Coronary Artery Disease: Preliminary
Results of Radionuc1ide Cineangiographic Studies . . . . . . . . . . . .. 91
F. M. Weld, J. T. Bigger,jr., J. Coronilas, L. M. Rolnitzky, and W. E. DeTurk
The Prognostic Significance of Ventricular Arrhythmias After Acute
Myocardial Infarction: Is It Independent of Left Ventricular Function? 95
VIII Table of Contents
G. Breithardt, M. Borggrefe, and L. Seipel
Significance of Late Ventricular Potentials for the Identification of
Patients at Risk of Sudden Death or Ventricular Tachycardia After Acute
Myocardial Infarction ............................. 102
W. C. Sheldon, W. L. Proudfit, A. V. G. Bruschke, and J. S. Lim
Prognosis in Patients with Mild Coronary Atherosclerosis . . . . . 111
G. G. Gensini
Prognosis of Patients with Normal Coronary Arteries at Middle Age .. 118
J. Jehle, M. Heerdt, P. Spiller, A. Krian, and F. Loogen
Follow-Up of Patients with Left Ventricular Aneurysm and Nonsurgical
Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
M. Stolte, D. Wittek, and B. Braun
Progression and Regression of Coronary Arteriosclerosis - A Pathologist's
Point of View .................................. 130
J. R. Kramer, H. Kitazume, W. L. Proudfit, Y. Matsuda, G. W. Williams,
and F. M. Sones, jr.
Progression of Coronary Atherosclerosis in Nonoperated Patients:
Relation to Risk Factors ......................... . 137
P. Stiirzenhofecker, K. Peters, E. Steinmann, P. Betz, and H. Roskamm
Progression of Coronary Arteriosclerosis in Nonoperated Patients . 141
M. G. Bourassa, M. Enjalbert, L. Campeau, and J. Lesperance
Progression of Coronary Artery Disease Between 10 and 12 Years After
Coronary Artery Bypass Graft Surgery . . . . . . . . . . . . . . . . . . . . 150
R. W. Brower, P. W. Serruys, and P. G. Hugenholtz
Progression and Regression of Disease in the Native Coronary Circulation
and Bypass Graft Surgery ........................... 157
R. T. Palac, M. H. Hwang, W. R. Meadows, H. S. Loeb,
C. Gohlke-Biirwolf, R. Pifarre, and R. M. Gunnar
The Influence of Medical and Surgical Therapy on Progression of
Coronary Artery Disease - Insights From a Randomized Study ... 165
M. H. Frick, M. Valle, and P.-T. Harjola
Progression of Coronary Artery Disease: A Prospective Angiographic
Study of Medical and Surgical Patients ................... 177
W. Rafflenbeul, S. Peters, M. Kreft, and P. R. Lichtlen
Quantitative Coronary Angiography: Progression and Regression of
Coronary Artery Disease Over 3-5 Year Intervals ............. 184
Table of Contents IX
W. Wijns, P. W. Serruys, M. van den Brand, H. Suryapranata,
C. J. Kooijman, J. H. C. Reiber, and P. G. Hugenholtz
Progression to Complete Coronary Obstruction Without Myocardial
Infarction in Patients Who Are Candidates for Percutaneous Transluminal
Angioplasty: A 90-Day Angiographic Follow-Up .............. 190
V.Kallio
The Influence of Physical Rehabilitation and Risk-Factor Control on
Long-Term Prognosis of Postinfarction Patients ............... 196
A. Hjalmarson and L. Wilhelmsen
The Influence of Beta-Blockers on Long-Term Prognosis in Postinfarction
Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
C. R. Klimt and S. A. Forman
Secondary Prevention of Myocardial Infarction with Antiplatelet Drugs. 218
E. A. Loeliger
Oral Anticoagulants and! or Aspirin ..................... 223
J. F. Hansen
The Influence of Verapamil Treatment During Acute Myocardial
Infarction on Long-Term Prognosis . . . . . . . . . . . . . . . . . . . . . . 231
W.-D. Bussmann
The Possible Influence of Nitrates on Prognosis in Patients with Coronary
Heart Disease ................................... 232
E. Varnauskas
Selection of Patients for Coronary Bypass Surgery 239
Subject Index .................... . 246
List of Contributors*
Bachmann, K. 241 Goldberg, H. L. 91 Peters, K. 141
Balcon, R. 36 Gunnar, R. M. 165 Peters, S. 184
Betz, P. 54, 141 Hansen, J. F. 231 Pifarre, R. 165
Bigger, J. T., Jr. 95 Harjola, P.-T. 177 Palac, R. T. 165
Borer, J. S. 91 Heerdt, M. 123 Proudfit, W. L. 111,
Borggrefe, M. 102 Hjalmarson, A. 207 137
Bourassa, M. G. 150 Holmes, J. 91 Rafflenbeul, W. 184
Breithardt, G. 102 Holzberger, H. 24 Reiber, J. H. C. 190
Brand, von den, M. Hugenholtz, P. G. 157, Rolnitzky, L. M. 95
190 190 Roskamm, H. 54, 141
Braun, B. 130 Hwang, M. H. 165 Samek, L. 54
Brower, R. W. 157 Jehle, J. 123 Seipel, L. 102
Bruce, R. A. 16 Kallio, V. 196 Serruys, P. W. 157, 190
Bruschke, A. V. G. 111 Kaltenbach, M. 36 Sheldon, W. C. 111
Bussmann, W. D. 36, Kitazume, H. 137 Sones, F. M. 137
232 Klimt, C. R. 218 Spiller, P. 123
Campeau, L. 150 Kooijman, C. J. 190 Steinbrunn, W. 1
Cattell, M. 36 Kramer, J. R. 137 Steinmann, E. 141
Coronilas, J. 95 Kreft, M. 184 Stolte, M. 130
DeTurk, W. E. 95 Krian, A. 123 Stiirzenhofecker, P. 141
Enjalbert, M. 150 Lesperance, J. 150 Suryapranata, H. 190
Fisher, J. 91 Lichtlen, P. R. 1, 184 Valle, M. 177
Forman, S. A. 218 Lim, J. S. 111 Varnauskas, E. 239
Frick, M. H. 177 Loeb, H. S. 165 Wallis, J. 91
Froelicher, V. F. 67 Loeliger, E. A. 223 Weld, F. M. 95
Fuchs, H. 24 Loogen, F. 123 Wijns, W. 190
Gensini, G. G. 118 Matsuda, Y. 137 Wilhelmsen, L. 207
Gohlke, H. 54 Meadows, W. R. 165 Williams, G. W. 137
Gohlke-Barwolf, C. Moses, J. W. 91 Wittek, D. 130
165 Niederer, W. 24 Wong, K. 36
* The address of each first mentioned author is indicated below the according contribution
heading
Page, on which contribution commences
I
Prognosis of Patients with Coronary Heart Disease Evaluated
Using Data Obtained by Invasive Methods
W. Steinbrunn and P. R. Lichtlen
Cardiology Section, Department of Medicine, University Hospital, 8091 Zurich, Switzerland
Studies on the natural history of coronary disease have established that the an
giographic appearance of coronary and left ventricular anatomy and function
(Obermann et al. 1972; Humphries et al. 1974; Bruschke et al. 1973a,b; Web
ster et al. 1974; Burggraf and Parker 1975; Nelson et al. 1975; Hammermeister
et al. 1979; Harris et al. 1979) are reliable predictors of survival. However, the
value of several of these studies has been questioned because of their retro
spective character, the relatively small number of patients, the short follow-up,
the lack of comparison with an age- and sex-matched normal population, and
the selection for coronary surgery of a considerable proportion of the original
population that underwent angiography. Furthermore, most of these studies do
not provide any information regarding the quality of life experienced by sur
viving patients.
The present study, although not entirely freed of these strictures, provides
more meaningful information in view of the long follow-up period. All survi
vors were followed up for periods ranging from 7 to 13 years after angiogra
phy. The mortality for the study group was compared with the mortality for an
age-matched general population. Furthermore, recruitment of patients began
in 1965 and ended in 1971, a time when relatively few myocardial revasculariza
tion procedures were being performed at the University Hospital of Zurich. It
can be assumed that the study population is representative of the coronary pa
tients studied at that time. Finally, it is noteworthy that surviving patients were
also analyzed with regard to their "quality of life" at an average of 9.3 years
after angiography.
Methods
Patient Population
The study was based on 644 consecutive coronary angiograms performed in the
laboratory of the University Hospital of Zurich by one of us (P.R.L.) between
September, 1965 and September, 1971. The indications for angiography were
angina pectoris or myocardial infarction with or without angina. We also used
it to evaluate the necessity of revascularization procedures (Vineberg's internal
mammary implantation, patch grafts, vein grafts) and to confirm the clinical dia
gnosis of coronary artery disease. A total of 369 patients manifested signifi
cant obstructions (~50% reduction of lumen diameter) of at least one major
2 w. Steinbrunn and P. R Lichtlen
coronary artery (right coronary artery, left anterior descending branch, left cir
cumflex branch) but no other cardiac disease. Of the 369 patients, 114 (31%)
underwent myocardial revascularization procedures within 12 months as a con
sequence of angiography and were therefore excluded from this study. Two pa
tients with selective right coronary injections only were eliminated, as were
three cases where contact was lost from the beginning.
Accordingly, the study group consisted of 250 patients, 238 men and 12 wo
men, with a mean age of 49.2 years (range: 28-72 years) at the time of angio
graphy. Ten patients (9 men, 1 woman) underwent coronary artery bypass sur
gery 14 months-9.3 years (mean 3.7 years) after the first angiogram. This group
and the group of the 11 other woman were too small to warrant the detailed
analysis performed on the remaining patients, the 229 unoperated men. Fifteen
patients (6%) were lost to follow-up after an observation time ranging from 3
months to 7 years (mean 2.3 years). These patients are included in the study as
"withdrawn alive."
Data Collection
Selective coronary arteriography was performed in at least two oblique projec
tions (RAO 15-40° and LAO 40-60°) by the Sones technique in 247 patients
and by the Judkins technique in three. The extent of coronary artery disease
was classified on a three-vessel scale (right coronary artery, left anterior de
scending, and left circumflex branch).
In 173 of these 229 patients complete studies with adequate left ventricular
visualization at cineangiocardiography were available. They were separated
into two groups: group I consisted of 61 patients for whom coronary artery by
pass surgery would have been possible according to currently accepted criteria,
and group II was comprised of 112 patients for whom surgery was not advisa
ble.
Current anatomical indications for the bypass operation are: proximal le
sion of 50% or more in one or more coronary arteries, with distal segments suit
able for grafting and which are perfusing myocardium presumed to be viable
on the basis of documented contraction of LV segments and absence of an
electrocardiographic Q-wave in the area in question.
Left ventriculograms were performed in a 30° RAO projection as a routine
starting in 1968 in 173 of the 229 patients after the coronary angiogram. Wall
motion was defined as normal, hypokinetic (reduced contraction), akinetic (ab
sent contraction), or dyskinetic (paradoxical movement) in one or more of
three left ventricular wall segments (anterior, apical, inferior). Ejection frac
tions were calculated using the area-length method (Dodge et al. 1960) from
134 ventriculograms, where border recognition was easily ascertained in the
absence of premature beats.
The cinefilms were interpreted at the time of the study by one of us (P.R.L.)
and during reevaluation by the other (W.S.), independently. In the absence of
concurrence a third cardiologist reviewed the films. Only four angiographic