Circulation, Vol 90, 2645-2657, Copyright © 1994 by American Heart Association
M Emond, MB Mock, KB Davis, LD Fisher, DR Holmes Jr, BR Chaitman, GC Kaiser, E Alderman and T Killip 3rd
BACKGROUND: This study describes the impact of clinical, angiographic, and
demographic characteristics on the long-term survival of Coronary Artery
Surgery Study (CASS) patients while they were under medical treatment.
Revascularization rates for the population are also provided. METHODS AND
RESULTS: All CASS patients who had not received heart surgery before
enrollment (23,467 patients) were included in this survival analysis while
they were under medical treatment or surveillance. Follow-up time ranged
from 0 to 17 years (median, 12 years). Long-term vital status is known for
95.8% of these patients. Log-rank tests, Kaplan-Meier survival curves, and
Cox proportional- hazards regression are used to describe and assess the
impact of patient characteristics on survival. Characteristics that had a
significant impact on survival, in order of observed explanatory power, are
age, number of diseased vessels, congestive heart failure score, smoking
history, ejection fraction, sex, presence of left main coronary artery
disease, presence of diabetes, left ventricular wall motion score, presence
of other illnesses, history of myocardial infarction, and presence of left
main equivalent disease. Overall, 12-year survival for patients with zero-,
one-, two- and three-vessel disease is 88%, 74%, 59%, and 40%,
respectively. Twelve-year survival for patients with at least one diseased
vessel and ejection fractions in the ranges of 50% to 100%, 35% to 49%, and
0% to 34% is 73%, 54%, and 21%, respectively. High myocardial jeopardy,
high anginal class, and two or three proximal diseased vessels characterize
the profile of patients most likely to have received surgical treatment
during follow-up. CONCLUSIONS: These results contribute to the
understanding of the natural history of coronary artery disease and are
also of historical interest. The poor survival of patients with
three-vessel disease and low ejection fractions continues to emphasize the
importance of considering revascularization for these patients.
ARTICLES
Long-term survival of medically treated patients in the Coronary Artery Surgery Study (CASS) Registry
Coordinating Center for Collaborative Studies in Coronary Artery Surgery, University of Washington, Seattle 98105.
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|
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|
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|
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|
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|
|
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|
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|
|
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|
|
|
|
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|
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|
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|
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|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
F.J. Pinto Myocardial viability: the search for a perfect method is not over yet Eur. Heart J., July 1, 2000; 21(13): 1039 - 1040. [PDF]
|
|
|
|
|
|
R Erbel, A Schmermund, S Mohlenkamp, S Sack, and D Baumgart Electron-beam computed tomography for detection of early signs of coronary arteriosclerosis Eur. Heart J., May 1, 2000; 21(9): 720 - 732. [PDF]
|
|
|
|
|
|
S. Westaby HEART FAILURE: Non-transplant surgery for heart failure Heart, May 1, 2000; 83(5): 603 - 603. [Full Text]
|
|
|
|
|
|
D Pagano, M E Lewis, J N Townend, P Davies, P G Camici, and R S Bonser Coronary revascularisation for postischaemic heart failure: how myocardial viability affects survival Heart, December 1, 1999; 82(6): 684 - 688. [Abstract] [Full Text]
|
|
|
|
|
|
S. M. Grundy, R. Pasternak, P. Greenland, S. Smith Jr, and V. Fuster Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: A statement for healthcare professionals from the American Heart Association and the American College of Cardiology J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1348 - 1359. [Full Text] [PDF]
|
|
|
|
|
|
S. M. Grundy, R. Pasternak, P. Greenland, S. Smith Jr, and V. Fuster Assessment of Cardiovascular Risk by Use of Multiple-Risk-Factor Assessment Equations : A Statement for Healthcare Professionals From the American Heart Association and the American College of Cardiology Circulation, September 28, 1999; 100(13): 1481 - 1492. [Full Text] [PDF]
|
|
|
|
|
|
F. A. Chaudhry, J. T. Tauke, R. S. Alessandrini, G. Vardi, M. A. Parker, and R. O. Bonow Prognostic implications of myocardial contractile reserve in patients with coronary artery disease and left ventricular dysfunction J. Am. Coll. Cardiol., September 1, 1999; 34(3): 730 - 738. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Schmermund, A. E. Denktas, J. A. Rumberger, T. F. Christian, P. F. Sheedy II, K. R. Bailey, and R. S. Schwartz Independent and incremental value of coronary artery calcium for predicting the extent of angiographic coronary artery disease: Comparison with cardiac risk factors and radionuclide perfusion imaging J. Am. Coll. Cardiol., September 1, 1999; 34(3): 777 - 786. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Pagano, P.G. Camici, and R.S. Bonser Revascularisation for chronic heart failure: a valid option? Eur J Heart Fail, August 31, 1999; 1(3): 269 - 273. [Full Text] [PDF]
|
|
|
|
|
|
S. M. Grundy Primary Prevention of Coronary Heart Disease : Integrating Risk Assessment With Intervention Circulation, August 31, 1999; 100(9): 988 - 998. [Full Text] [PDF]
|
|
|
|
|
|
A. Pasquet, A. Robert, A.-M. D'Hondt, R. Dion, J. A. Melin, and J.-L. J. Vanoverschelde Prognostic Value of Myocardial Ischemia and Viability in Patients With Chronic Left Ventricular Ischemic Dysfunction Circulation, July 13, 1999; 100(2): 141 - 148. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Gibbons, K. Chatterjee, J. Daley, J. S. Douglas, S. D. Fihn, J. M. Gardin, M. A. Grunwald, D. Levy, B. W. Lytle, R. A. O'Rourke, et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina) J. Am. Coll. Cardiol., June 1, 1999; 33(7): 2092 - 2197. [Full Text] [PDF]
|
|
|
|
|
|
A. M. Garber and N. A. Solomon Cost-Effectiveness of Alternative Test Strategies for the Diagnosis of Coronary Artery Disease Ann Intern Med, May 4, 1999; 130(9): 719 - 728. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Scanlon, D. P. Faxon, A.-M. Audet, B. Carabello, G. J. Dehmer, K. A. Eagle, R. D. Legako, D. F. Leon, J. A. Murray, S. E. Nissen, et al. ACC/AHA guidelines for coronary angiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1756 - 1824. [Full Text] [PDF]
|
|
|
|
|
|
A. Schmermund, K. R. Bailey, J. A. Rumberger, J. E. Reed, P. F. Sheedy II, and R. S. Schwartz An algorithm for noninvasive identification of angiographic three-vessel and/or left main coronary artery disease in symptomatic patients on the basis of cardiac risk and electron-beam computed tomographic calcium scores J. Am. Coll. Cardiol., February 1, 1999; 33(2): 444 - 452. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. O. Myers, E. H. Blackstone, K. Davis, E. D. Foster, and G. C. Kaiser CASS registry: Long term surgical survival J. Am. Coll. Cardiol., February 1, 1999; 33(2): 488 - 498. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Zaacks, P. R. Liebson, J. E. Calvin, J. E. Parrillo, and L. W. Klein Unstable angina and non-Q wave myocardial infarction: does the clinical diagnosis have therapeutic implications? J. Am. Coll. Cardiol., January 1, 1999; 33(1): 107 - 118. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. F. Di Carli, J. Maddahi, S. Rokhsar, H. R. Schelbert, D. Bianco-Batlles, R. C. Brunken, and B. Fromm LONG-TERM SURVIVAL OF PATIENTS WITH CORONARY ARTERY DISEASE AND LEFT VENTRICULAR DYSFUNCTION: IMPLICATIONS FOR THE ROLE OF MYOCARDIAL VIABILITY ASSESSMENT IN MANAGEMENT DECISIONS J. Thorac. Cardiovasc. Surg., December 1, 1998; 116(6): 997 - 1004. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. D. Guerci, L. A. Spadaro, K. J. Goodman, A. Lledo-Perez, D. Newstein, G. Lerner, and Y. Arad Comparison of electron beam computed tomography scanning and conventional risk factor assessment for the prediction of angiographic coronary artery disease J. Am. Coll. Cardiol., September 1, 1998; 32(3): 673 - 679. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Gotsman and D. Admon Paradigm Shifts in Coronary Artery Disease: The Old New Initiatives Arch Intern Med, May 11, 1998; 158(9): 949 - 953. [Full Text] [PDF]
|
|
|
|
|
|
J. Denollet and D. L. Brutsaert Personality, Disease Severity, and the Risk of Long-term Cardiac Events in Patients With a Decreased Ejection Fraction After Myocardial Infarction Circulation, January 20, 1998; 97(2): 167 - 173. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Schmermund, D. Baumgart, G. Gorge, R. Seibel, D. Gronemeyer, J. Ge, M. Haude, J. Rumberger, and R. Erbel Coronary Artery Calcium in Acute Coronary Syndromes : A Comparative Study of Electron-Beam Computed Tomography, Coronary Angiography, and Intracoronary Ultrasound in Survivors of Acute Myocardial Infarction and Unstable Angina Circulation, September 2, 1997; 96(5): 1461 - 1469. [Abstract] [Full Text]
|
|
|
|
 |
|
 D. Hasdai, K. N. Garratt, D. E. Grill, A. Lerman, and D. R. Holmes Effect of Smoking Status on the Long-Term Outcome after Successful Percutaneous Coronary Revascularization N. Engl. J. Med., March 13, 1997; 336(11): 755 - 761. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. H. Ling, M. Enriquez-Sarano, J. B. Seward, A. J. Tajik, H. V. Schaff, K. R. Bailey, and R. L. Frye Clinical Outcome of Mitral Regurgitation Due to Flail Leaflet N. Engl. J. Med., November 7, 1996; 335(19): 1417 - 1423. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Pilote, D. P. Miller, R. M. Califf, J. S. Rao, W. D. Weaver, and E. J. Topol Determinants of the Use of Coronary Angiography and Revascularization after Thrombolysis for Acute Myocardial Infarction N. Engl. J. Med., October 17, 1996; 335(16): 1198 - 1205. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A. Caracciolo, K. B. Davis, G. Sopko, G. C. Kaiser, S. D. Corley, H. Schaff, H. A. Taylor, and B. R. Chaitman Comparison of Surgical and Medical Group Survival in Patients With Left Main Equivalent Coronary Artery Disease : Long-term CASS Experience Circulation, May 1, 1995; 91(9): 2335 - 2344. [Abstract] [Full Text]
|
|
|
|
 |
|
 LONG-TERM SURVIVAL PROFILED FOR MEDICALLY-TREATED CAD Journal Watch (General), December 27, 1994; 1994(1227): 6 - 6. [Full Text]
|
|