Ischemic heart disease. Precarious coronary lesions and prognosis.

Coronary arteriograms in 113 patients whose cases were followed for 2 to 12 years were analyzed in an attempt to discover why in some patients with angina pectoris there are long stable clinical courses and in others the courses proceed rapidly to death. It was found that patients with completed coronary occlusions, usually with distal portions reconstituted by collateral, had favorable prognoses with prolonged longevity. Patients with multiple high grade narrowings of the coronary arteries, on the other hand, had poor prognoses with high attrition rates. The more stenotic lesions present in the coronary arteries, the higher the attrition rates. Completed coronary occlusions, therefore, have been classified as nonprecarious while local coronary stenoses greater than 50 percent of the lumen diameter have been classified as degrees of precariousness according to the number of lesions present. When compared with classification by number of diseased vessels and by arteriographic score of Friesinger, the nonprecarious cases had better prognoses than the precarious.