Alderman E L, Corley S D, Fisher L D, Chaitman B R, Faxon D P, Foster E D, Killip T, Sosa J A, Bourassa M G
Cardiovascular Medicine Division, Stanford University Medical Center, California.
J Am Coll Cardiol. 1993 Oct;22(4):1141-54. doi: 10.1016/0735-1097(93)90429-5.
The Coronary Artery Surgery Study (CASS) required participants to undergo follow-up angiography at 5 years to identify clinical and angiographic features associated with progression of coronary artery disease.
The CASS randomized 780 patients at 11 participating clinical centers between an initial strategy of medical therapy versus bypass surgery. Five clinical sites accomplished follow-up angiography in > 50% of their randomized subjects within a 42- to 66-month period after the entry arteriogram (n = 314).
Qualified clinical site angiographers, using side by side film review, evaluated an average of 13 segments/patient on both arteriograms for initial stenosis severity, morphologic features, lesion location and occurrence of disease progression or occlusion. Progression was defined as further definite narrowing by > or = 15% and occlusion as lesion progression to > or = 98%. Lesions were subcategorized as to whether they were univariate and had or had not been treated with bypass surgery. Multivariate logistic regression analyses were performed.
For nonbypassed segments, right coronary artery and left anterior descending artery proximal and midlocations were associated with disease progression. For stenosis-containing segments, the initial severity, a non-left anterior descending artery location and increased treadmill duration predicted progression. Segment occlusion was associated with initial lesion severity, right coronary artery location and subsequent interval myocardial infarction. There were few predictors of progression or occlusion in bypassed arteries, other than initial lesion severity.
Univariate and multivariate associations with lesion progression and occlusion included diabetes, lesion location, elevated cholesterol level, interval infarction and lesion morphology. These angiographic results, collected in a prospective trial, are consistent with known risk factors.
冠状动脉外科研究（CASS）要求参与者在5年时接受随访血管造影，以确定与冠状动脉疾病进展相关的临床和血管造影特征。
CASS在11个参与研究的临床中心将780例患者随机分为初始药物治疗策略组和搭桥手术组。5个临床地点在入组动脉造影后42至66个月内，对超过50%的随机分组受试者进行了随访血管造影（n = 314）。
合格的临床地点血管造影师采用并排胶片评估法，对每位患者的两张动脉造影照片上平均13个节段进行初始狭窄严重程度、形态学特征、病变位置以及疾病进展或闭塞情况的评估。进展定义为进一步明确狭窄≥15%，闭塞定义为病变进展至≥98%。病变根据是否为单因素以及是否接受过搭桥手术进行亚分类。进行多因素逻辑回归分析。
对于未搭桥节段，右冠状动脉以及左前降支近端和中段与疾病进展相关。对于含狭窄节段，初始严重程度、非左前降支位置以及运动平板试验时间延长可预测进展情况。节段闭塞与初始病变严重程度、右冠状动脉位置以及随后的间隔期心肌梗死相关。除初始病变严重程度外，搭桥动脉中进展或闭塞的预测因素很少。
与病变进展和闭塞相关的单因素和多因素关联包括糖尿病、病变位置、胆固醇水平升高、间隔期梗死以及病变形态。这些在前瞻性试验中收集的血管造影结果与已知的危险因素一致。
