Five-year angiographic follow-up of factors associated with progression of coronary artery disease in the Coronary Artery Surgery Study (CASS). CASS Participating Investigators and Staff.
OBJECTIVE
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.


BACKGROUND
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).


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Alderman
E L
EL
Cardiovascular Medicine Division, Stanford University Medical Center, California.
Corley
S D
SD
Fisher
L D
LD
Chaitman
B R
BR
Faxon
D P
DP
Foster
E D
ED
Killip
T
T
Sosa
J A
JA
Bourassa
M G
MG
D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D048909:Diabetes Complications; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D015588:Observer Variation; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index