In a group of 205 patients with isolated significant stenosis (75% or greater) of the left anterior descending coronary artery, the clinical and prognostic importance of the following factors was analyzed: type, location and severity of the stenosis; presence of collateral vessels, of associated subcritical (50%) lesions of other vessels, of previous myocardial infarction; and left ventricular contraction pattern. The clinical importance of the above factors was evaluated by analyzing their influence on symptoms, exercise tolerance and left ventricular function. The location of the stenosis proved to influence symptoms: thus patients with distal lesions were in less severe conditions. The presence of collateral vessels was associated with an impaired exercise tolerance: therefore it appeared to be a sign of clinical severity, not a factor of protection. The severity of the stenosis and previous myocardial infarction unfavorably influenced left ventricular function. The presence of associated subcritical lesions of other vessels did not affect clinical picture. Prognostic implications of the above factors were evaluated with regard to natural history, surgical risk and long term results of postoperative survivors. The following factors showed an unfavorable influence on natural history: single lesion; proximal site; 90% reduction of the vessel area; absence of collaterals and of previous myocardial infarction; presence of associated 50% stenosis of other vessels. A higher surgical risk was noted in proximal lesions, in the presence of previous anterior infarction, of associated subcritical lesions of other vessels. Analysis of long term history of postoperative survivors suggests that surgery improves survival of the group of patients with particularly high spontaneous risk.
|Translated title of the contribution||Single vessel coronary artery disease. II. Isolated lesions of the left anterior descending coronary artery: Clinical and prognostic importance of some factors|
|Number of pages||17|
|Journal||Giornale Italiano di Cardiologia|
|Publication status||Published - 1979|
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine