PROGRESSION OF NATIVE CORONARY-ARTERY DISEASE AT 10 YEARS - INSIGHTS FROM A RANDOMIZED STUDY OF MEDICAL VERSUS SURGICAL THERAPY FOR ANGINA

Repeat coronary angiography was performed in 42 patients 10 years after randomization to medical (n = 21) or surgical (n = 21) therapy for chronic angina. The native coronary arteries were classified into 15 angiographic segments and 3 arterial trunks for analysis of progression of coronary artery disease. The incidence rate of disease progression in coronary segments was 24% and 28% in medically and surgically treated patients, respectively (p :: NS). Grafted segments showed a 38% rate of disease progression, which was higher than the 18% rate for nongrafted segments (p < 0.001) and the overall rate of 21% for medically treated patients (p < 0.01). Similarly, 29 (94%) of 31 grafted arteries exhibited disease progression compared with 19 (59%) of 32 nongrafted arteries (p < 0.01) and 42 (67%) of 63 arteries in medically treated patients (p < 0.01). In grafted vessels, disease progression occurred more often in arteries proximal (84%) to the anastomosis than in arteries distal (16%) to graft insertion (p < 0.001). Progression occurred in 46% of proximal segments compared with 23% of distal segments (p < 0.02). Progression was seen in 23 (55%) of 43 segments with an occluded graft compared with 30 (31%) of 96 segments with a patent graft (p < 0.02). Ten years after randomization, medically and surgically treated patients showed a comparable rate of disease progression in coronary segments. However, surgical therapy appeared to significantly accelerate atherosclerotic progression in the grafted vessels, especially in the proximal portions. Occluded grafts also correlated with an adverse effect on disease progression. These long-term effects should be taken into consideration when aortocoronary bypass surgery is contemplated. © 1990.