Circulation, Vol 87, 1067-1075, Copyright © 1993 by American Heart Association
D Waters, TE Craven and J Lesperance
BACKGROUND. Angiographic progression of coronary atherosclerosis is
frequently observed in clinical practice and is used as an end point in
clinical trials; however, its prognostic significance is unclear. METHODS
AND RESULTS. Progression defined as an increase in diameter stenosis by
> or = 15% of at least one coronary lesion was seen in 141 (42%) of 335
patients who underwent repeat coronary arteriography after a 2-year
interval as part of clinical trial. Coronary lesions were measured
quantitatively from comparable end-diastolic frames selected by a
radiologist viewing each pair of films together. During a mean follow-up of
44 +/- 10 months after the second arteriogram, cardiac death occurred in 19
patients (5.7%), cardiac death or nonfatal infarction was seen in 40 cases
(11.9%), and 90 patients (26.9%) underwent coronary revascularization. At
least one end point event occurred in 112 of the 335 patients. Sixteen of
the 19 cardiac deaths were in progressors, a relative risk of 7.3 (95% CI,
2.2-24.7; p < 0.001). The relative risk of cardiac death or nonfatal
infarction for progressors was 2.3 (1.3-4.2, p = 0.009) and of any cardiac
event was 1.7 (1.3-2.3, p < 0.001). A stepwise multivariable Cox
regression model of time to event was used to assess the relative
contribution of progression as a predictor of coronary events. Low ejection
fraction (p = 0.001), progression (p = 0.001), and hypertension (p = 0.011)
were retained as predictors of cardiac death. Angina and the number of
diseased vessels were the strongest predictors of revascularization.
CONCLUSIONS. Coronary progression is a strong, independent predictor of
future coronary events, particularly cardiac death, and its use as a
surrogate end point in clinical trials is justified.
ARTICLES
Prognostic significance of progression of coronary atherosclerosis
Department of Medicine, Montreal Heart Institute.
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