Angiographic progression to total coronary occlusion in hyperlipidemic patients after acute myocardial infarction

The progression of coronary artery stenosis to total occlusion was assessed in 413 hyperlipidemic patients with a previous myocardial infarction. Coronary angiograms were recorded at baseline, 3 (n = 312), and 5 years (n = 248) after initial study and analyzed by 2 independent readers. There were 177 (43%) patients with 1-, 130 (31%) with 2-, and 61 (15%) with 3-vessel disease (greater than or equal to 50% diameter narrowing), whereas 45 (11%) did not have significant disease within a major coronary vessel at baseline. A new finding of total occlusion occurred in 4% (30 of 748) and 7% (40 of 605) of major coronary artery segments at 3 and 5 years, respectively. The risk of progression to total occlusion was higher if the initial stenosis was greater than 60% compared to lesions less than or equal to 60% both at 3 years (19 of 143 = 13% vs 11 of 605 = 2%; p less than 0.001) and 5 years (27 of 91 = 30% vs 13 of 514 = 3%; p less than 0.001). The frequency of occlusion was highest for the right coronary artery by 5 years (18 of 167 = 11% for right vs 8 of 225 = 4% for circumflex vs 14 of 213 = 7% for left anterior descending coronary arteries; p less than 0.02). Clinical and laboratory data revealed that myocardial infarction was associated with a new total occlusion in 23% of patients (7 of 30) at 3 years and in 64% (25 of 39) at 5 years.(ABSTRACT TRUNCATED AT 250 WORDS)