Clinical Course of Patients with Normal, and Slightly or Moderately Abnormal Coronary Arteriograms

In a series of 500 patients who had normal coronary arteriograms or narrowings < 50% of the lumen diameter the subsequent clinical course was studied. The minimum follow-up period was 5 years. In 342 patients with entirely normal coronary arteriograms there were only two (0.6%) presumed cardiac deaths and three (0.9%) acute myocardial infarctions within 5 years; both incidences are about half the expected rates in the average unselected population of the United States matched by sex and age. In 101 patients with mild abnomalities (<30% narrowing of the lumen diameter) the prognosis was less good than in the normal group but still better than in the average population. In 57 patients with moderate abnormalities (30 to less than 50% narrowing) there were three (5.3%) presumed cardiac deaths and two (3.5%) myocardial infarctions within 5 years; both incidences are higher than in the average population. Serial arteriograms were made in 20 cases and showed progression of the disease in the majority of cases with moderate narrowings, but progression or development of narrowings in only one of the cases with normal arteries or mild narrowings. Other determinants included in this study appeared to have limited predictive value regarding the clinical course. It is concluded that the coronary arteriogram contains major predictive information. Normal findings indicate an excellent prognosis regardless of other diagnostic parameters; moderate abnormalities indicate the early phase of an essentially progressive disease.