Progression of Coronary Artery Disease

Significant progression of coronary artery disease was seen in 52% of subjects studied by selective cinearteriography at intervals between 2 and 75 months (average 23.8). Subsequent progression, although confined to proximal areas, was independent of overall severity of initial disease or previous disease at the site of progression and occurred frequently in previously normal vessels. Plasma lipid abnormalities and myocardial lactate production at the time of the initial study were significantly associated with subsequent arteriographic progression. Similarly abnormal glucose tolerance was seen more frequently in patients exhibiting progression than in those who did not. The progression occurring in patients with lipid abnormalities was more severe and more widespread than in other patients, and apparent interval reduction in lipid values did not influence the ultimate course of the atheromatous process. Myocardial infarction was almost invariably associated with progression. Collateral coronary circulation never increased or appeared unless accompanied by an increase in the extent of local coronary artery disease. The absence of progression was associated with a favorable prognosis. All other clinical, laboratory, and arteriographic parameters analyzed were not predictive of subsequent progression of the coronary obstructive lesion.