Coronary heart disease in residents of Rochester, Minnesota. IV. Prognostic value of the resting electrocardiogram at the time of initial diagnosis of angina pectoris.

The data in this study were based on the 1,154 Rochester residents in whom a resting electrocardiogram had been obtained at the time of diagnosis of angina pectoris as the initial manifestation of coronary heart disease during the 26-year period 1950 through 1975. The finding of a normal electrocardiogram at the time of the initial diagnosis of angina pectoris was associated with a good prognosis. Survival at 5 years was equal to that expected, for the given age and sex distribution, under a cohort life table for the Minnesota white population. In contrast, in those patients who had an abnormal electrocardiogram at the time of diagnosis, the observed survival rate was 86% of that expected at 5 years.

Coronary heart disease in residents of Rochester, Minnesota, 1950-1975. III. Effect of hypertension and its treatment on survival of patients with coronary artery disease.

The data in this blood pressure study were obtained from 1,069 patients who had their first manifestation of coronary artery disease during the 16-year period 1960 through 1975. Case fatality rates (death within 30 days) were least in the normotensive and treated hypertensive patients with myocardial infarction and greatest in the untreated hypertensive patients. Women were less likely than men to acquire coronary artery disease, but a higher proportion of women with coronary artery disease had hypertension. Patients with definite hypertension were older than those with borderline hypertension, and patients with borderline hypertension were older than normotensive patients with coronary artery disease. The data demonstrate that hypertension is a prognostic factor of serious significance in patients who have symptomatic coronary artery disease, and the prognostic significance of borderline hypertension is almost as serious as that of definite hypertension in these patients. Treatment improved survival in patients with definite hypertension, and adequate treatment improved survival to a greater degree than did inadequate treatment.

Coronary heart disease in residents of Rochester, Minnesota, 1950-1975. I. Background and study design.

The unique medical data resource for the population of Rochester, Minnesota, is centered on the records of the Mayo Clinic and the Olmsted Medical and Surgical Group, which for several decades have provided nearly all medical care in this community. This resource has been utilized in a study of the incidence rates and secular trend in coronary heart disease for the period 1950-1975 among residents of Rochester. A total of 3,080 patients fulfilled the clinical and other criteria for inclusion in this study. The patients, classified by initial manifestation of coronary heart disease, consisted of 1,321 with myocardial infarction, 1,215 with angina pectoris, and 544 with sudden unexpected death. In this paper the background, clinical definitions, and study design are presented.

Isolated replacement of the mitral valve with the Starr-Edwards prosthesis.

Isolated mitral valve replacement with the Starr-Edwards prosthesis has been performed on 657 patients at the Mayo Clinic during the 11 year period ending January, 1972. The most recent subset of that series comprised patients who received the Model 6120 prosthesis. In this group, the operative mortality rate was 9 per cent and the actuarial late death rate at 5 years was 20 per cent. This survival rate is a significant improvement over the natural history of severe mitral valve disease. Factors associated with operative deaths are large left artrial size, advanced functional class, and previous heart surgery. Variables associated with higher incidence of late deaths are large left atrial size, patient age at operation, and multivalve disease. Risk of thromboembolism is increased with large left atrial size, presence of left atrial thrombus, and inadequate anticoagulant therapy.

Isolated replacement of the aortic valve with the Starr-Edwards prosthesis. A 9 year review.

A 9 year review of patients who underwent replacement of the aortic valve with the Starr-Edwards prosthesis indicates that the operative mortality rate for aortic valve replacement continues to decline. Thromboembolic complications have been markedly lessened in newer model valves. Surgical therapy is no longer seriously questioned as the appropriate management for symptomatic aortic valvular disease. The large majority of patients who survive surgery can expect to be rehabilitated to a highly functional existence, with longevity not unlike that of the general population. The Starr-Edwards prosthesis is a very satisfactory prosthesis for replacement of the aortic valve.

Mitral valve replacement with the Smeloff-Cutter prosthesis. Experience with 154 patients and comparison with results of replacement with a Starr-Edwards prosthesis.

Mitral valve replacement with the Smeloff-Cutter (S-C) prothesis was performed in 154 patients between September, 1965, and January, 1970. In 84, only the mitral valve was replaced; in the remainder, other valves were reconstructed or replaced. The hospital and late mortality rates for isolated replacement were 6 and 25 per cent, respectively. Comparable figures for the Starr-Edwards (S-E) (Models 6000 and 6120) prosthesis during this period were 11 and 23 per cent. Similar rates of thromboembolism were associated with the use of either prosthesis in surviving patients (27 per cent for the S-C valve and 30 per cent for the S-E valve). In spite of the acceptable hospital mortality rate for the S-C valve, it is not now considered suitable for clinical use because of the high late mortality rate and the high risk of thromboembolism that accompany its use.

Long-term follow-up of isolated replacement of the aortic or mitral valve with the Starr-Edwards prosthesis.

Review of 1,684 cases of isolated aortic or mitral valve replacement with a Starr-Edwards prosthesis demonstrated that the procedure provides improved life expectancy over that found in the natural history of valvular heart disease. Further improvement in results depends on continued reduction in operative and late mortality and in the incidence of thromboembolism. Advanced preoperative functional class, atrial or ventricular enlargement, a history of prior heart surgery, advanced age at operation and untreated valvular disease were among the factors related to increased early or late mortality. The data suggest that adequate anticoagulation, earlier performance of valve replacement and more complete repair of valvular dysfunction may increase survival rates.