Eighty-four patients with previous uncomplicated isolated inferior myocardial infarction underwent coronary arteriography to determine the prevalence and distribution of coronary stenoses in order to identify those patients at high risk for early death. Coronary risk factors and treadmill stress testing were evaluated as predictors of left coronary artery disease, and the clinical course was compared of patients undergoing coronary bypass surgery versus those treated medically. Of the 84 patients, 17 (20 percent) had one vessel stenosis (75 percent or more luminal narrowing), 29 (35 percent) had stenosis of two and 38 (45 percent) had stenosis of all three major coronary arteries. Fifty-three patients (63 percent) had stenosis of the proximal left anterior descending coronary artery including 8 with complete and 18 with subtotal occlusion. Of the 53 patients with proximal left anterior descending arterial stenosis, 42 (79 percent) had an operable condition (no distal obstruction) as did 36 (69 percent) of 52 with circumflex arterial stenosis. Although the presence of multiple coronary risk factors, particularly with a positive stress test, was predictive of multivessel stenosis, lack of risk factors and a negative exercise test were nonspecific. Of 45 patients followed up for 18 months, 14 who underwent, coronary bypass surgery were compared with 31 medically treated patients with similar cardiac function and coronary pathoanatomy. Ten surgically treated patients (71 percent) had reduced angina compared with nine medically treated patients (29 percent) (P < 0.05): Two surgically treated patients (14 percent) had no change in angina compared with 17 medically treated patients (54 percent) (P < 0.05). Only two surgically treated patients (14 percent) had increased angina compared with five medically treated patients (16 percent) (P > 0.05). Thus, serious left coronary artery disease is highly prevalent as well as operable in patients with chronic inferior myocardial infarction. The latter condition thereby provides a clinically useful and sensitive marker of high risk coronary arterial stenosis.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine