title: The natural history of single-vessel chronic coronary occlusion: a 25-year experience.
abstract: To determine the natural history of patients with a total occlusion of a single coronary artery, we searched the Duke Databank for Cardiovascular Disease to find all patients who underwent a first coronary angiogram >2 days after a symptomatic myocardial infarction between 1969 and 1994. Patients who underwent angiography >30 days after the acute event had a low risk of death in the first year (3%), and a proximal left anterior descending coronary occlusion did not confer substantially higher risk of death (4%). Patients undergoing angiography <30 days after the acute event had a higher mortality (5%), especially those with proximal left anterior descending occlusion (10%). The time from the acute event to angiography was a predictor of death (p = 0.04). Despite low 1-year mortality rates, patients with total occlusion of an isolated coronary vessel treated medically had substantial mortality, myocardial infarction, and revascularization rates over a long-term follow-up period.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Puma
authors.forename: M H
authors.initials: MH
authors.lastname: Sketch
authors.forename: J E
authors.initials: JE
authors.lastname: Tcheng
authors.forename: L H
authors.initials: LH
authors.lastname: Gardner
authors.forename: C L
authors.initials: CL
authors.lastname: Nelson
authors.forename: H R
authors.initials: HR
authors.lastname: Phillips
authors.forename: R S
authors.initials: RS
authors.lastname: Stack
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
mesh_terms: D000328:Adult; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D015331:Cohort Studies; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors