Normal Coronary Arteriogram in a Patient with Clinical Evidence of Myocardial Infarction

¹ Cardiovascular Service, Lenox Hill Hospital, New York City

The case of a 61-year-old man in whom coronary arteriography was normal eight weeks after unmistakable clinical evidence of acute myocardial infarction is discussed to illustrate problems occasioned by the introduction of coronary arteriography. There is a growing tendency to consider the coronary arteriogram as the sine qua non for diagnosis of obstructive artery disease while disregarding clinicopathologic observations gathered and refined over many years. A normal coronary arteriogram in the presence of clinical evidence of coronary heart disease almost always elicits an explanation for the clinical findings other than the possibility that a good quality coronary arteriogram may fail to demonstrate significant coronary artery disease. The coronary arteriogram must be correlated with pathologic findings in many more patients before it can be accepted as the ultimate criterion upon which, not only diagnosis of coronary artery disease depends, but also evaluation of work capacity, disability compensation and other socioeconomic problems associated with coronary artery disease.