title: Patients with coronary artery disease not amenable to traditional revascularization: prevalence and 3-year mortality.
abstract: OBJECTIVE
  To determine the contemporary prevalence of and mortality in patients with coronary artery disease (CAD) not amenable to revascularization.
  
  
  BACKGROUND
  A growing number of patients have severe CAD with ongoing angina despite optimal medical therapy which is not amenable to traditional revascularization. Limited data exist on contemporary prevalence and outcome for these patients.
  
  
  METHODS
  Clinical and angiographic data were reviewed for 493 consecutive patients undergoing coronary angiography and revascularization if indicated. Patients were categorized into six groups: (1) normal coronary arteries, (2) CAD <70%, (3) CAD >70% with complete revascularization by percutaneous intervention or coronary artery bypass grafting, (4) CAD >70% with partial revascularization, (5) CAD >70% treated medically, and (6) CAD >70% on optimal medical therapy with no revascularization option. All-cause mortality at 3 years was determined.
  
  
  RESULTS
  Prevalence for groups 1-6 was 14.8, 19.5, 36.9, 12.8, 9.3, and 6.7%, respectively. Three-year mortality increased with angiographic severity of CAD: 2.7, 6.3, 8.2, 12.7, 17.4, and 15.2%, respectively. Patients with incomplete revascularization (groups 4-6, n = 142) had higher mortality than completely revascularized patients (groups 1-3, n = 351): 14.8 vs. 6.6% (P = 0.004).
  
  
  CONCLUSIONS
  In a contemporary series of patients undergoing coronary angiography, 28.8% (142/493) of patients had significant CAD and did not undergo complete revascularization, including 12.8% partially revascularized, 9.3% managed medically, and 6.7% with "no-option." These patients had higher mortality at 3 years (14.8 vs. 6.6%, P = 0.004) when compared with completely revascularized patients.
authors.affiliation: Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota 55407, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Williams
authors.forename: Madhav
authors.initials: M
authors.lastname: Menon
authors.forename: Daniel
authors.initials: D
authors.lastname: Satran
authors.forename: Daniel
authors.initials: D
authors.lastname: Hayward
authors.forename: James S
authors.initials: JS
authors.lastname: Hodges
authors.forename: M Nicholas
authors.initials: MN
authors.lastname: Burke
authors.forename: Randall K
authors.initials: RK
authors.lastname: Johnson
authors.forename: Anil K
authors.initials: AK
authors.lastname: Poulose
authors.forename: Jay H
authors.initials: JH
authors.lastname: Traverse
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Henry
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index