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The devolutionary pattern of coronary atherosclerosis in patients with angina pectoris was studied in 47 persons cinearteriographically. Two subsets of patients were identified at the initial examination. The first comprised 12 patients who did not have coronary atherosclerosis. In these 12, the cinearteriographic findings remained normal on repeated study 15 to 73 months later. The second subset included 35 patients with severe obstructive coronary atherosclerosis. When coronary visualization was repeated 15 months later, arterial disease remained stable in 11 patients (31.4 percent). Significant progression of the arterial disease was observed in the remaining 24 patients (68.5 percent). The frequency of hyperlipidemia, clinical diabetes, systolic and diastolic hypertension and a positive family history of coronary heart disease was not significantly different in those with stable and progressive disease. Furthermore, the distribution of the initial disease did not distinguish one group from the other. Since collateral channels were more prolific in patients who ultimately were classified as having stable arterial disease, it is possible that the initial severity of disease in this group was greater than in those with progressive disease. None in the latter group noted a reduction in the frequency or severity of angina pectoris. One third of those with stable disease did record such a reduction. However, paradoxically, two patients with stable coronary disease had a new myocardial infarction in the interval between examinations. Our findings suggest that the devolutionary pattern of coronary atherosclerosis in patients with angina pectoris as observed cinearteriographicaliy is unpredictable and apparently unrelated to commonly cited risk factors. They indicate that the severity of angina pectoris is the most precise guide to progressive coronary artery disease even though progressive disease can occur without affecting angina. The occurrence of myocardial infarction in patients with stable disease underscores the fact that many determinants influencing myocardial perfusion are not identified by cinearteriography. |
