[Natural and postoperative course of coronary disease in late observations: prognostic value of clinical indicators and invasive and non-invasive studies].

The results of a prospective study in 301 patients (pts) with angiographically documented coronary artery disease are presented. The mean follow-up period was 30 +/- 14 months, the mean age of pts was 48 +/- 9 years. A prognostic significance of 37 indicators obtained from clinical, hemodynamical, angiographical and noninvasive studies was investigated. In the group of pts treated medically (n = 202) the natural history of disease was defined by the following indicators: history of myocardial infarction, congestive heart failure, NYHA functional class III and IV, frequent ventricular premature depolarizations (VPD), abnormal ecg at rest, QT greater than QS2 index, left ventricular (LV) ejection fraction less than 50%, elevation of LV end-diastolic pressure and LV end-diastolic volume index LV wall motion abnormalities in particular dyskinesia, left main coronary artery disease and three vessel coronary artery disease. In a multivariate Cox model analysis, the independent correlates of long-term survival were frequency of VPD (p less than 0.001), NYHA functional class III-IV (p less than 0.003), QT greater than QS2 index (p less than 0.01), LV ejection fraction (LVEF) less than 50% (p less than 0.02). The combination of two indicators: LVEF less than 50% and QT greater than QS2 identify pts with high mortality rate (31%) during a two year follow-up period as compared with only 1% in the group with LVEF greater than or equal to 50% and QT less than or equal to QS2. The different clinical and hemodynamical characteristics of both the groups of pts treated medically or surgically made a reliable comparison of those two methods of treatment impossible.