[Mortality of subjects with coronary insufficiency with severe, tritruncal and diffuse arterial lesions].

The cases of 151 patients with diffuse, severe, triple coronary vessel disease excluding any possibility of aortocoronary bypass surgery with a Ross and Friesinger index of over 10/15 were analysed for survival by direct methods up to 5 years and by actuarial methods up to 8 years. The global mortality rate was 36% at 5 years and 53% at 8 years. Excluding 10 non-cardiac deaths, the annual mortality rate was 7%. When the 9 cases of left main stem disease, responsible for 6 deaths in 5 years (annual mortality of 13%) were excluded, the annual mortality of the remaining 132 cases was 6% per year. The actual degree of arterial stenosis did not significantly affect the outcome in these patients selected by the severity of their coronary lesions. Mortality was significantly higher when there was a history of angina of over 3 years duration. All clinical, radiological and electrocardiographic parameters indicating myocardial dysfunction (cardiac failure, radiological cardiomegaly, intraventricular conduction defects, left ventricular hypertrophy) had a decisive influence on mortality. A decreased ejection fraction was a poor prognosis factor associated with a 2.5% increase in the annual mortality rate for each 10% decrease of ejection fraction under 50%. Although no differences were found irrespective of whether coronary angiography was performed in an acute context (during a preinfarction syndrome), most of the survival graphs showed a clearcut increase in the downward slope during the first 6 months, indicating a mortality rate four to eight times higher than during later periods.