Background Coronary artery disease (CAD) is a major public and economic health problem. Coronary angiography is a gold standard for diagnosing CAD and is indicated in patients with 61–90% pre-test probability of the disease when the diagnosis cannot be made on clinical grounds alone and when revascularisation is being considered. The natural history of normal coronary angiogram is poorly understood.
Objectives To evaluate the progression of disease in patients with normal coronary angiography and to assess the overall survival and event-free survival from acute myocardial infarction (MI) in these patients.
Methods We interrogated the Central Cardiac Audit Database (CCAD) between November 2005 and December 2013 to identify patients with normal or ‘near-normal’ coronary angiography. Demographic, clinical and angiographic data was recorded. This database was linked with the Patient Episode Database for Wales (PEDW) and the datasets from the Office for National Statistics (for mortality) using the Secure Anonymised Information Linkage (SAIL) databank. This allowed for the extraction of information from all the sources above on the basis of the International Statistical Classification of Diseases (ICD-10) using the Structured Query Language (SQL).
Results Out of over 20,000 patients undergoing coronary angiography between November 2005 and December 2013, 5032 patients had normal coronaries and minor CAD. Of 5032 patients, 136 underwent repeat angiography, with 131 (96.3%) and 5 (3.7%) patients having two and three repeat investigations respectively. Mean time between procedures was 3.3 (±1.82) years. Of those 136 patients, at the median follow up of 6.8 years, no change in disease progression was demonstrated in 108 (79.4%) patients on the follow up studies. In the remaining 28 (20.6%) patients, normal coronaries progressed to minor CAD. No patients progressed beyond minor CAD. Patients with normal coronaries had significant better survival than patients with minor CAD (p < 0.05), but survival free from MI was >99.5% in both groups at the median of 5 years follow up. (p = 0.09)
Conclusions Normal coronary angiography and minor CAD is unlikely to progress to significant disease at 7 years and the incidence of MI in these patients is rare at 5 years. Therefore, repeating coronary angiography within at least 5 years is not indicated.
- Coronary Heart Disease
- Coronary Angiography
- Normal Coronary Arteries
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