Analysis of the evolution of coronary artery disease--evaluation of 227 cases by restudy of coronary arteriography.

Some 227 patients who showed a 50% or greater narrowing of at least one major coronary artery in the first study underwent recatheterization at a mean interval of 35.6 months. Coronary arterial lesions and the degree of narrowing [i.e., normal (absent), 25%, 50%, 75%, 90%, 99% and complete occlusion (100%)] were classified in accordance with the AHA reporting system. When the lesions in the second study showed a change of equal or more than 2 in the above 7 stages in comparison with the first study, either progression or regression was determined. Of the 227 patients, progression occurred in 73 (32%) and regression was found in 7 (3%). In the aggravated group in symptom, progression was noted in 58%, and even in the stabilized group, progression was observed in 22%. As a result of the second study, 15 (21%) out of 73 patients showing progression underwent surgical treatment, and more than half of these cases (9/15) were constituted by the stabilized group. During the above follow-up periods, myocardial infarction occurred subsequently in 14 (19%) out of 73 patients showing progression. Up to the present time, sudden deaths occurred in 8 patients, and 5 out of 8 patients were also of the stabilized group. The authors wish to emphasize from these findings the necessity of aggressively pursuing restudy even in stabilized cases showing symptoms of ischemic heart disease.