Medical management of significant coronary angiographic stenoses: Outcome of 60 patients observed for 433 patient years

Background: Percutaneous transluminal coronary angioplasty (PTCA) has becom e routine in the management of patients with stable angina pectoris and sig nificant coronary stenoses, while medical management of such patients has d eclined. Hypothesis: The purpose of the present study was to evaluate the outcome of 60 patients at the Virginia Heart Institute with stable angina pectoris, o bserved between 1976 and 1997, who had documented evidence of severe angiog raphic disease but were elected to be monitored and managed in an outpatien t pharmacologic rehabilitation program. Methods: Sixty patients with significant stenoses by coronary angiography ( 21 with single-vessel, 26 with double-vessel, and 13 with triple-vessel) wi thout impaired ventricular function, exercise-induced ischemia or hypotensi on, limited exercise performance, malignant arrhythmias, or drug intoleranc e were enrolled in a program of pharmacologic rehabilitation and observed f or an average of 7.2 years. Results: Among the 60 patients, there were 6 deaths at a mean interval of 8 .3 years. Two deaths were in patients ineligible for revascularization. Ano ther patient who died had refused revascularization after new-onset left ve ntricular dysfunction, and another died intraoperatively during abdominal a ortic aneurysm repair. Two patients died while exercising. Thirteen patient s underwent follow-up catheterization for worsening angina; 11 of 13 showed progression, predominantly from new lesions. Four of 11 were referred for revascularization; 7 of 11 continued medical treatment; 49 patients were st able on medical therapy throughout the period of observation. Conclusion: Medical management of selected patients with significant corona ry stenoses is safe and effective.