To examine the prognostic significance of total cholesterol levels at baseline in subjects with stable coronary heart disease, 605 patients with stable coronary heart disease were enrolled; 45 of these did not meet inclusion criteria, 41 were lost to follow-up and 40 opted for coronary bypass surgery. Data of the remaining 479 (389 males, 90 females) were analysed. There were 102 males in group I (cholesterol < 200 mg/dL), 187 in group II (cholesterol 200-239 mg/dL), and 100 in group III (cholesterol > or = 240 mg/dL) and 49 females in group I and 41 in group II. The groups were evenly matched for age and numbers with stable angina or survivors of myocardial infarction. Proportion of smokers, hypertensives, diabetics or obese was also similar (p > 0.05). Mean follow-up in years in men was 6.82 +/- 3.15 in group I, 6.37 +/- 3.11 in group II and 6.81 +/- 2.84 in group III while in women it was 6.95 +/- 2.84 in group I and 7.03 +/- 2.58 years in group II and was not different in various groups (p > 0.05). The overall cardiovascular mortality in various groups in men was 20.6 percent in group I, 28.9 percent in group II and 23.0 percent in group III and in women it was 14.3 percent in group I and 22.0 percent in group II. The crude mortality rate was 2.51 percent per year in males and 1.77 percent per year in females. Actuarial survival at end of seven years in males was 0.76 +/- 0.05 in group I, 0.67 +/- 0.04 in group II, and 0.67 +/- 0.05 in group III and in females it was 0.85 +/- 0.05 in group I and 0.73 +/- 0.09 in group II. The cumulative hazard rates per 1000 person- year follow-up in group I, II and III in males were, at age less than 50 years: 5.4 +/- 5, 19.8 +/- 7, 17.4 +/- 8; at 50-59 years: 23.8 +/- 11, 38.5 +/- 9, 39.8 +/- 13; and at 60 years and over: 76.9 +/- 20, 112.6 +/- 20, 108.2 +/- 28, respectively (p < 0.001 on comparison of group I with groups II and III). In females the trends were not significant. Total cholesterol levels at baseline predict long-term cardiovascular mortality in men with stable coronary heart disease.

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Long term follow up study of prognostic significance of exercise duration during treadmill stress test in patients with stable coronary heart disease.

Treadmill stress tests provide useful noninvasive prognostic information in patients with coronary heart disease (CHD). The present study has prospectively analysed the long term prognostic value of exercise tolerance as measured by exercise time during treadmill stress test in 335 consecutive patients with stable CHD. 161 had exercise time of 6 minutes or less (mean 4.58 +/- 1.54 minutes) on a modified protocol (Group A) and 174 had exercise time of more than 6 minutes (mean 9.30 +/- 0.74 minutes)(Group B). Both groups were matched for major coronary risk factors (hypertension, smoking, diabetes and cholesterol levels) and type of drug therapy (betablockers, nifedipine, diuretics and aspirin). The patients have been followed up for upto 9 years with a mean of 6.28 +/- 2.99 years (Group A) and 7.87 +/- 1.98 years (Group B). Actuarial analysis shows that the overall survival after dropout due to death or coronary artery bypass surgery was significantly lower in group A [dropouts = 66 (41.0%)] than in Group B [dropouts = 19 (10.9%)] (Logrank test = 39.94, p < 0.001). The mortality was significantly higher in Group A with 58 deaths (36.0%) as compared to Group B with 16 deaths (9.2%) (x2 = 34.98, p < 0.001). The crude death rate was 5.73% per year in Group A as compared to 1.17% per year in Group B. The incidence of sudden deaths was also higher in Group A with 28(17.4%) instances as compared to 5(2.9%) in Group B (x2 = 19.85, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

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Total cholesterol and mortality in patients with pre-existing coronary artery disease.

BACKGROUND: A positive correlation exists between serum cholesterol levels and cardiovascular mortality. However, the role of serum cholesterol in persons with pre-existing coronary artery disease is not clear. METHODS: A cohort of 524 patients with coronary artery disease was divided into four groups based on the total serum cholesterol values. Group I consisted of 68 patients with cholesterol levels of 200 mg/dl or less; Group II of 116 patients with cholesterol levels between 201 and 220 mg/dl; Group III of 187 patients with levels between 221 and 240 mg/dl and Group IV of 153 patients with cholesterol levels greater than 240 mg/dl. RESULTS: Actuarial survival analysis over an 11-year follow up did not show any overall difference in mortality between these groups (Logrank test statistic = 1.89, p > 0.1). Analysis after adjustment of the data also showed that mortality rates were not different (chi (2) = 4.73, p > 0.05). Hazard function analysis indicated that death rates per thousand person years of follow up were 49.97 +/- 8.4 in Group I, 41.38 +/- 8.4 in Group II, 55.39 +/- 4.4 in Group III and 45.38 +/- 6.4 in Group IV. These were also not statistically significant. Comparison of mortality rates in patients with angina pectoris and past myocardial infarction also showed similar results. CONCLUSION: Total serum cholesterol levels do not influence long term survival in patients with pre-existing coronary artery disease.

Actuarial Analysis↗

PubMedDate not supplied

Prognostic value of profound ST segment depression during treadmill stress test in coronary heart disease: nine years follow-up study.

To define the prognostic significance of profound ST segment depression (greater than or equal to 3mm) during exercise test, 106 patients of definite coronary heart disease enrolled in a prospective study were followed for up to 9 years. Group A (56 patients) had profound (greater than or equal to 3mm) ST segment depression (3.56 +/- 0.74mm) and Group B (50 patients) had less than 3mm ST segment depression (1.23 +/- 0.35mm, P less than 0.01) during treadmill testing. Group A patients tolerated exercise for a lesser duration in comparison to group B patients (7.22 +/- 3.35 vs. 10.18 + 4.07 minutes, p less than 0.01). At the end of the study, 21 (37.5%) group A patients either died or underwent coronary artery bypass surgery as compared to 8 (16.0%) group B patients (p = 0.02). The difference in the incidence of cardiac deaths between the two groups was not statistically significant (19.6% in group A and 14.0% in group B). However, sudden deaths were significantly more common in group A as compared to group B patients (10 of 11 (90.9%) vs 4 of 7 (57.1%), p = 0.02). These data suggest that profound ST segment depression (greater than 3mm) during treadmill stress test indicates an adverse long term prognosis with the risk in particular, of sudden cardiac death.

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