Author + information
- Received July 11, 1988
- Revision received December 15, 1988
- Accepted January 6, 1989
- Published online June 1, 1989.
- Stephen Ellis, MD, FACCa,b,
- Edwin L. Alderman, MD, FACC∗,a,b,
- Kevin Cain, PhDa,b,
- Allan Wright, MDa,b,
- Martial Bourassa, MD, FACCa,b,
- Lloyd Fisher, PhD, FACCa,b,
- the participants of the Coronary Artery Surgery Study (CASS)a,b,∗
- ↵∗Address for reprints:Edwin L. Alderman, MD, Cardiology Division, Stanford University Medical Center, P2033, Stanford, California 94305.
Despite a growing awareness of the correlation of coronary artery stenoses morphology with clinical syndromes, no comprehensive, prospective analysis of the implications of stenosis morphology on risk of myocardial infarction has been reported. Angiograms from 118 patients, representative of the 4.9% of medically treated Coronary Artery Surgery Study (CASS) patients who during subsequent 3 year follow-up study had an anterior myocardial infarction, were matched on the basis of arteriographic anatomy and disease with 141 patients who did not have an anterior infarction. Angiograms from these 259 patients with 557 left anterior descending artery stenoses were reviewed without knowledge of clinical outcome. Conditional regression analyses were performed to determine the importance of stenosis morphology, relative to computer-determined stenosis severity and other clinical variables, in the prediction of risk of infarction.
Univariate analysis revealed luminal roughness (odds ratio 4.5; p = 0.001) and lesion length (odds ratio 1.7 per unit length; p = 0.007) to be highly correlated with future risk of infarction. Multivariate analysis revealed left anterior descending artery percent stenosis >_50%, lesion roughness, left circumflex artery stenosis and smoking, in that order, to be predictive of anterior myocardial infarction, whereas 22 other morphologic variables were not independently predictive of outcome. The importance of stenosis roughness may relate to its propensity for thrombogenesis and should be considered in clinical decision making.
↵∗ A complete list of CASS contributing investigators and participating clinical centers appears in J Am Coll Cardiol 1984;3:113-28.
☆ This project was supported by the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, Maryland as a collaborative clinical trial (CASS) and by an NHLBI training grant.
☆☆ The quality of the cineangiographic films in this study is a tribute to the work of Melvin P. Judkins, MD, who organized Coronary Artery Surgery Study (CASS) workshops on angiography and initiated quality control efforts. We express special appreciation to Gary Sanders and Adriana Krauss for their assistance in compiling our data base and to Susan Groechel for secretarial assistance.
- Received July 11, 1988.
- Revision received December 15, 1988.
- Accepted January 6, 1989.