Surgical Significance of Angiographic Patterns in Coronary Arterial Disease

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Abstract
A review of 313 selective cine coronary arteriograms performed in patients with angina pectoris is presented. Classification of coronary arterial disease by location and severity of stenosis has established certain patterns of disease. Significant disease (greater than 75% stenosis of at least one major vessel) occurred in 270 of 313 (89%) patients. Significant single-vessel disease occurred in only 58 of 270 (23%) patients, while the occurrence of significant multiple-vessel disease was: double, 110 of 270 (40%) patients; triple, 78 of 270 (29%) patients; and quadruple, 24 of 270 (9%) patients. The distribution in 191 arterial occlusions was: right coronary, 101 of 191 (53%); anterior descending, 64 of 191 (33%); and circumflex, 26 of 191 (14%). Anterior and anterior-lateral myocardial ischemia occurred in 80 of 270 (29%) patients, isolated posterior myocardial ischemia in 46 of 270 (18%) patients, and equal anterior and posterior ischemia in 144 of 270 (53%) cases. The angiographic studies were correlated with clinical history and electrocardiographic findings. The frequency of severe posterior myocardial ischemia, either alone or in conjunction with severe anterior ischemia, indicates the need for selective posterior or total myocardial ischemia, either alone or in conjunction of patients are to benefit from myocardial revascularization.

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