Follow-up of patients from the Coronary Artery Surgery Study (CASS) potentially suitable for percutaneous transluminal coronary angioplasty

To determine the proper place for percutaneous transluminal coronary angioplasty (PTCA) among the therapeutic options available for patients with coronary heart disease, one must compare the results of PTCA with those obtained by conventional medical and surgical therapy. To develop a cohort comparison group, we interrogated the Coronary Artery Surgery Study (CASS) registry, and patients with proximal discrete subtotal stenosis (70% to 99%) involving the right, left anterior descending, circumflex, or left main coronary artery, singly or with stenoses in two of the three major coronary arteries, were selected; 796 patients (3.7% of all patients enrolled in CASS from 1975 to 1979) met these selection criteria. Surgical therapy was chosen in 53.3%; surgical mortality was low and there was excellent 4-year actuarial survival. There was significant improvement in functional class. Survival was also excellent in medically treated patients. Medically treated patients also had significant improvement in functional class in comparison with baseline values. The data prosented here characterize a cohort group against which the clinical results of PTCA can be evaluated and compared.