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This study examined clinical characteristics of patients with total occlusion of all three coronary vessels. Each left anterior descending coronary artery (LAD). left circumflex coronary artery (LCX) and right coronary artery (RCA) showed total occlusion angiography in 15 patients (mean age 64, male 11, female 4) selected from 9,245 consecutive patients who underwent coronary angiography. Twelve of these 15 patients had a history of myocardial infarction, while the other three patients had no history of infarction. Survival rate of CABG group (n=5) was 80% (1yr), 80% (2yrs) and 80% (5yrs), while that of medical group (n=10) was 90% (lyr), 45% (2yrs) and 45% (5yrs). Subjects (medical group) of this study were divided into two groups. The first group consisted of the survi-vors (A group ; male 5. female 1). It was made up of patients with total occlusion of all three coronary vessels and the other group consisted of those who died (B group ; male 3, female 1) after final coronary angio-graphy. In the A group, the left ventricular ejection fraction (LVEF) was significantly greater than that of the B group (58±10% vs 32±9%, p< 0.05). However age, gender, the history of angina pectoris, the term of follow-up and coronary risk factors did not differ significantly between two groups. In all subjects, good collateral supply was found in the distal portions of the occluded vessels from branches located in those areas, such as the conus branch, right ventricular branch, septal branch and left atrial circumflex branch. In LAD and LCX, the occluded portions of the vessels were usually located at the mid portion (A group ; LAD-proximal 2/6, mid 4/6, LCX-proximal 0/6, mid 6/6 vs B group ; LAD-proximal 1/4, mid 3/4, LCX-proximal 0/ 4, mid 4/4). However in RCA, many of the occlusion sites in the A group involved distal portions compared to those in the B group (A group ; proximal 2/6, mid 4/ 6, distal 1/6 vs B group ; proximal 3/4, mid 0/4, distal 1/4). Therefore in the A group, the collateral supply to LAD from RCA was sufficient, but it was not sufficient in the B group. LVEF correlated with the degree of collateral supply and in the B group, sudden death occurred in all patients (4/4, 100%) during conservative treatment. These findings suggest that mid portion occlusion, good collateral supply and a long history of angina pectoris are important factors involved in total occlusion of all three coronary vessels. Good collateral supply to LAD from RCA may be especially important for survival under these severe circumstances.


Copyright © 1996, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1200 印刷版ISSN 0452-3458 医学書院

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