ANGIOGRAPHIC PROGRESSION TO TOTAL CORONARY-OCCLUSION IN HYPERLIPIDEMIC PATIENTS AFTER ACUTE MYOCARDIAL-INFARCTION

The progression of coronary artery stenosis to total occlusion was assessed in 413 hyperlipidemic patients with a previous myocardial infarction. Coronary angiograms were recorded at baseline, 3 (n = 312), and 5 years (n = 248) after initial study and analyzed by 2 independent readers. There were 177 (43%) patients with 1-, 130 (31%) with 2-, and 61 (15%) with 3-vessel disease (≥ 50% diameter narrowing), whereas 45 (11%) did not have significant disease within a major coronary vessel at baseline. A new finding of total occlusion occurred in 4% (30 of 748) and 7% (40 of 605) of major coronary artery segments at 3 and 5 years, respectively. The risk of progression to total occlusion was higher if the initial stenosis was >60% compared to lesions ≤60% both at 3 years (19 of 143 = 13% vs 11 of 605 = 2%; p < 0.001) and 5 years (27 of 91 = 30% vs 13 of 514 = 3%; p < 0.001), The frequency of occlusion was highest for the right coronary artery by 5 years (18 of 167 = 11% for right vs 8 of 225 = 4% for circumflex vs 14 of 213 = 7% for left anterior descending coronary arteries; p < 0.02). Clinical and laboratory data revealed that myocardial infarction was associated with a new total occlusion in 23% of patients (7 of 30) at 3 years and in 64% (25 of 39) at 5 years. Serum cholesterol and triglyceride levels were significantly higher in patients with a new finding of total occlusion at 5 years. This prospective serial angiographic study showed that the extent of initial coronary artery narrowing was significantly associated with the risk of progression to total occlusion. © 1990.