Long-term survival in medically treated patients with ischaemic heart disease and prognostic importance of clinical and electrocardiographic data (the Italian CNR Multicentre Prospective Study OD1).

In order to study long-term survival in medically treated patients with ischaemic heart disease in our country and to evaluate the prognostic significance of clinical variables, 1083 patients less than 65 years old were followed up for a mean period of 66 months (min 36, max 93). All patients performed an exercise stress test and had coronary angiography. Vital status was known for 98.3% of the patients. The great majority were treated with calcium antagonists and nitrates. In the overall population, the annual cardiac mortality rate was 1.54%. On the basis of clinical variables, groups with a tenfold difference in mortality could be identified. The annual cardiac mortality was 0.29% in patients without myocardial infarction and effort ischaemia and reached 3.12% in those with extensive infarction and/or severe reduction of exercise tolerance. Among risk factors, only arterial hypertension was an independent predictor of mortality. According to angiographic variables, the highest mortality rate was 5.7% in patients with three-vessel disease and poor left ventricular function. When multivariate analysis was applied to clinically stratified subgroups, angiographic variables gave additional prognostic information on survival only in the subgroup with an intermediate prognosis. In conclusion (1) the annual cardiac mortality in our medically treated patients is low; (2) patients with very different prognoses may be identified on a clinical basis; (3) coronary angiography adds prognostic information only in moderately severe disease.