title: Conservative medication follow-up for over 20 years of a patient with ischemic heart disease after diagnosis of chronic total occlusion of the 3 main coronary arteries.
abstract: A 48-year-old man suffered from acute coronary syndrome in 1978. Coronary angiography was performed at that time and showed 99% stenosis of the right coronary artery, 100% of the left circumflex branch, and 50% of the left ascending artery. He received conservative therapy. Five years later (ie, 1983), coronary angiography showed complete occlusions of the 3 major coronary arteries. Rich collateral circulation had developed distal to all 3 major coronary trees. The patient and his family rejected invasive therapies such as coronary-artery bypass graft or percutaneous coronary intervention. Cardiac catheterizations were performed in 1996, 2001, and 2007, but angiographic follow-up studies showed no change in either the coronary atherosclerosis or the collateral circulation. The left ventricular ejection fraction has been maintained at >60%. During the 20-year follow-up, he has had refractory angina, but has not suffered from acute coronary syndrome, congestive heart failure, or critical arrhythmia.
authors.affiliation: Second Department of Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Tanaka
authors.forename: Chiharu
authors.initials: C
authors.lastname: Yokoyama
authors.forename: Itta
authors.initials: I
authors.lastname: Kawamura
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Takasugi
authors.forename: Tomoki
authors.initials: T
authors.lastname: Kubota
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ushikoshi
authors.forename: Takuma
authors.initials: T
authors.lastname: Aoyama
authors.forename: Masanori
authors.initials: M
authors.lastname: Kawasaki
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nishigaki
authors.forename: Genzou
authors.initials: G
authors.lastname: Takemura
authors.forename: Shinya
authors.initials: S
authors.lastname: Minatoguchi
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000188:drug therapy*; D000286:Administration, Sublingual; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000188:drug therapy; D000959:Antihypertensive Agents / Q000008:administration & dosage; D002908:Chronic Disease; D003097:Collateral Circulation; D017023:Coronary Angiography; D003331:Coronary Vessels; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005996:Nitroglycerin / Q000008:administration & dosage*; D012720:Severity of Illness Index; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents; D014665:Vasodilator Agents; D005996:Nitroglycerin