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

Cardiovascular Medicine Division, Stanford University Medical Center, California.

OBJECTIVES. 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.

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				G. W. Barsness, E. D. Peterson, E. M. Ohman, C. L. Nelson, E. R. DeLong, J. G. Reves, P. K. Smith, R. D. Anderson, R. H. Jones, D. B. Mark, et al. Relationship Between Diabetes Mellitus and Long-term Survival After Coronary Bypass and Angioplasty Circulation, October 21, 1997; 96(8): 2551 - 2556. [Abstract] [Full Text]

				S. G. Ellis and C. R. Narins Problem of Angioplasty in Diabetics Circulation, September 16, 1997; 96(6): 1707 - 1710. [Full Text]

				J. S. Forrester and P. K. Shah Lipid Lowering Versus Revascularization : An Idea Whose Time (For Testing) Has Come* Circulation, August 19, 1997; 96(4): 1360 - 1362. [Abstract] [Full Text]

				K. E. Kip, D. P. Faxon, K. M. Detre, W. Yeh, S. F. Kelsey, and J. W. Currier Coronary Angioplasty in Diabetic Patients: The National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry Circulation, October 15, 1996; 94(8): 1818 - 1825. [Abstract] [Full Text]

				D. Waters, J. Lesperance, P. Gladstone, S. J. Boccuzzi, T. Cook, R. Hudgin, G. Krip, and L. Higginson Effects of Cigarette Smoking on the Angiographic Evolution of Coronary Atherosclerosis: A Canadian Coronary Atherosclerosis Intervention Trial (CCAIT) Substudy Circulation, August 15, 1996; 94(4): 614 - 621. [Abstract] [Full Text]

				M. Enriquez-Sarano, E. Klodas, K. N. Garratt, K. R. Bailey, A. J. Tajik, and D. R. Holmes Secular Trends in Coronary Atherosclerosis -- Analysis in Patients with Valvular Regurgitation N. Engl. J. Med., August 1, 1996; 335(5): 316 - 322. [Abstract] [Full Text] [PDF]

				E. Falk and V. Fuster Angina Pectoris and Disease Progression Circulation, October 15, 1995; 92(8): 2033 - 2035. [Full Text]

				E. Falk, P. K. Shah, and V. Fuster Coronary Plaque Disruption Circulation, August 1, 1995; 92(3): 657 - 671. [Full Text]

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