PROGNOSIS OF NON-REVASCULARIZED TRIPLE VE SSEL DISEASE - RESULTS IN ASERIES OF 87 CASES

Between 1982 and 1988, 87 patients (74 men, 13 women), with an average age of 59.6 +/- 10.1 years, had triple coronary artery disease and di d not undergo any medical or surgical revascularisation, mainly becaus e of the severity of the coronary disease or left ventricular dysfunct ion. Sixty-four patients had previous myocardial infarction, 33 unstab le angina and 37 left ventricular failure. At coronary angiography, 31 patients had Class III or IV (NYHA) angina. The cardiothoracic ratio was 0.50 +/- 0.06; the left ventricular ejection fraction was 0.47 +/- 0.20. During follow-up of 3.9 +/- 2.6 years (2 patients lost to follo w-up), 35 patients died (26 of cardiac and 9 of non-cardiac causes), g iving a 5 year actuarial survival of 63 %. In univariate analysis, the factors predictive of increased cardiac mortality were: absence of al cohol consumption (p = 0.013); class 3 or 4 angina (p = 0.017); restin g angina (p = 0.030); cardiac failure (p = 0.0006); chest X ray showin g interstitial or alveolar oedema (p = 0.002); increased cardiothoraci c ratio (p = 0.003). A decreased left ventricular ejection fraction wa s only at the limit of statistical significance (p = 0.054). In multiv ariate analysis (Cox model), only 4 variables were correlated with inc reased cardiovascular mortality: resting angina (relative risk, RR = 2 .56), cardiac failure (RR = 2.55), increased cardiothoracic ratio (RR = 2.14), absence of alcohol consumption (RR = 4.43). These results con firm the poor prognosis of patients with triple vessel disease not rev ascularised. They show the value of clinical appreciation to determine the prognosis of these patients. They also suggest that the prognosis is worse in the case of total abstinence of alcoholic beverages.