Symptomatic coronary disease for 20 or more years: clinical aspects, angiographic findings, and therapeutic implications.

Clinical, angiographic, and therapeutic aspect of coronary artery disease of long duration (exceeding 20 years) is reviewed in 50 patients (study group) and compared to a control group of 100 consecutive patients with coronary artery disease of shorter duration. All were referred because of symptomatic coronary artery disease. The study group had a greater incidence of clinically evident extracardiac vascular disease (28% vs 4%) (p less than 0.01). Transmural infarction was more frequent in the study group (64% vs 45%). Triple-vessel and main left disease was observed respectively in 90% and 28% compared to 36% and 7% in the control group (p less than 0.01). Twenty-nine percent of collaterals were jeopardized in the study group compared to 13% of collaterals in controls (p less than 0.01). Abnormal left ventricular ejection fraction (p less than 0.05) was found in 50% of the study group compared to 28% of controls (p less than 0.01). Medical therapy was recommended for 36% of the study group with 11 of 18 (61%) considered inoperable, whereas in 39% of the control group medical therapy was continued, with 9 of 39 (23%) considered inoperable (p less than 0.01) Surgery or coronary angioplasty was recommended in 64% of the study and in 61% of the control group. No patient in the study group was considered a candidate for coronary angioplasty, whereas in 20% (12 of 61) of the control group coronary angioplasty was recommended. Patients with coronary artery disease for over 20 years have severe coronary artery disease, with one in four having main left disease.(ABSTRACT TRUNCATED AT 250 WORDS)