Symptoms of coronary artery disease generally occur in association with the obstruction of coronary arteries. The development of selective coronary cinearteriography has made possible the correlation of clinical syndromes and evidence of arterial obstruction during life.

The distribution and extent of atherosclerosis within the coronary arterial circulation is well known as an important determinant of treatment and prognosis, but reports of coronary artery disease confirmed by coronary arteriography are almost nonexistent in Korea.

We report, herein, clinical and coronary angiographic findings of 400 Korean adults with coronary artery disease which were confirmed by coronary angiography at the Department of Internal Medicine, Yonsei University College of Medicine.

Since selective coronary arteriography was first performed by Sones¹⁾ in 1958, there has been a remarkable development in the methodology of coronary arteriography^2–5). Nowadays, selective coronary arteriography is essential for the diagnosis of coronary artery obstructive disease (CAOD), determining treatment modality and prognosis.

In the developed countries, the literature is replete with reports of the clinical and angiographic findings of coronary artery disease^6–9). In Korea, however, reports coronary artery disease confirmed by coronary arteriography are still rare.

Herein, we report the clinical and coronary angiographic findings of 400 Korean adults with coronary artery disease confirmed by coronary arteriography.

In our study the sex ratio was 4 to 1. This result is similar to those of Kim et al¹⁰⁾ and Proudfit⁶⁾. Age distribution of our cases was 38% in the 6th, 29% in the 5th and 23% in the 7th decades.

Major risk factors for coronary atherosclerosis in male patients were smoking, hypertension, hypercholesterolemia (≥220 mg%) and diabetes mellitus in the order mentioned, but in female patients they were hypertension, hypercholesterolemia, diabetes mellitus and smoking. Kannel et al¹¹⁾ reported that although the serum total cholesterol is still quite useful for ascertaining risk at ages younger than 50, and probably improved at any age, by an HD lipoprotein cholesterol measurement. Anderson et al¹²⁾ reported that the degree of coronary artery occlusion was positively related to elevated cholesterol, elevated triglyceride, diabetes, age and history of smoking for both male and female patients and hypertension was related to the degree of occlusion only for female patients.

In this study, single vessel disease was more prevalent in the group with ustable angina including new-onset angina (53%) than in the stable angina group (47%). Victor et al¹³⁾, Roberts et al¹⁴⁾ and Lawson et al¹⁵⁾ also reported that new-onset angina group had a higher incidence of single vessel disease than those with chronic angina. The incidence of multi-vessel involvement was low in patients who had acute myocardial infarction (46%), in contrast to a much higher incidence in old myocardial infarction group, especially, with angina (76%). These finding were similar to that of Proudfit¹⁶⁾.

Among the 400 patients who had more than a 50% narrowing in luminal diameter in at least one vessel, 188 (47%) and single vessel involvement, 100 (25%), two vessel disease, 87 (22%), triple vessel disease and 25 (6%), left main disease. These findings were similar to those of Ljungberg et al¹⁷⁾, but Proundfit et al¹⁶⁾ and Bruschke et al⁸⁾ reported that two vessel disease was most prevalent. The incidence of the left main disease was 6% in our cases, 12% in the study of Ljungberg et al¹⁷⁾ and 10.1% in that of Proudfit et al¹⁶⁾.

The total number of coronary atherosclerotic lesions among the 400 patients was 895. The average number of arteries affected by the lesions exceeding 50% of the luminal diameter was 2.2 in our study, 1.8 in that of Ljungberg¹⁷⁾ and 2.0 in that of Proundfit et al¹⁶⁾. The distribution for the four arteries was left anterior descending artery 46%, left circumflex artery 26%, right coronary artery 25%, left main 3%. These findings were similar to those of Proudfit et al¹⁶⁾.

Although in our study lesions were more common in the left anterior descending branch of the left coronary artery than at other sites, the difference in incidence in comparison with involvement of the right coronary artery and the circumflex branch of the left coronary artery was not striking. Among 895 lesion sites, proximal (158) and mid (136) portions of left anterior descending coronary artery were the most prevalent sites.

Study of the distribution of severe arterial obstructions did not reveal a pattern characteristic of a clinical syndrome. Only limited conclusions can be reached. Lesions in the left main coronary artery were less common in patients who had myocardial infarction without angina pectoris than in the various groups of patients who had angina pectoris with or without myocardial infarction.

In the absence of anatomic patterns characteristic of a clinical syndrome, symptoms must depend on other variables such collateral circulation, the presence of functional arterial constriction, the cardiac output, the viability of the myocardium distal to the obstruction, the arterial blood pressure, and the regional coronary blood flow. In this study the presence or absence of evidence of collateral circulation was not noted, because this information was difficult to tabulate.

In this study we suggest that in Korea the prevalent age of CAOD is older and the incidence of multivessel disease is lower than that in the developed countries.