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Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
[Prognostic value of normal coronary angiography]
L Jacq1, C Chabredier-Paquot, M Pezzano
1Centre hospitalier sud-francilien, service de cardiologie, 51, boulevard Henri Dunant, 91108 Corbeil-Essonnes, France.
Insights
A normal coronary angiography, even with non-significant atheroma, rarely leads to acute coronary syndromes. This suggests a generally good prognosis for patients with seemingly normal coronary artery disease imaging.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Coronary angiography is the gold standard for diagnosing coronary artery disease (CAD).
- The prognostic significance of a "normal" coronary angiogram, particularly with non-obstructive atheroma, remains debated.
- Plaque rupture risk is not solely determined by stenosis degree.
Purpose of the Study:
- To evaluate the prognosis of patients with normal or subnormal coronary angiograms.
- To assess the incidence of adverse cardiac events in this population.
Main Methods:
- Retrospective analysis of 136 normal/subnormal coronary angiograms (January-September 1997).
- Patients categorized by indication: CAD suspicion, preoperative valvulopathy angiography, angioplasty control.
- Follow-up of 108 patients for 18 +/- 3 months.
Main Results:
- 86% had strictly normal arteries, 37% had <50% stenosis.
- Eight non-coronary deaths occurred (postoperative, pulmonary embolism, neoplasm).
- No myocardial infarctions reported; one unstable angina documented.
Conclusions:
- Acute coronary syndromes are rare complications of "normal" coronary angiograms.
- Despite non-significant atheroma, prognosis is generally favorable.
- Further investigation may be warranted for specific subgroups.
Abstract:
Coronary angiography is the "gold standard" for coronary artery disease (CAD). It is considered either normal or subnormal without any lesion (endocoronary echography often demonstrates atheroma), or in presence of a < 50% stenosis. Nevertheless, the risk of plaque rupture is not well correlated with the degree stenosis. Despite the frequent presence of non-significant atheroma, is a normal coronarography really of a good prognosis? Between January and September 1997, 136 of 600 (22.6%) angiographies were considered as normal. The indications were: "CAD suspicion" (n = 77), "preoperative angiography of valvulopathy" (n = 38), and "angioplasty control" (n = 22). The arteries were strictly normal for 86 patients (63%) and a < 50% stenosis was found in 50 patients (37%); 108 patients (80.1%) were followed for 18 +/- 3 months: eight non coronary deaths were reported: four postoperative deaths in "valvular group", two pulmonary embolisms and two pulmonary neoplasm's in "CAD suspicion group". No myocardial infarction was reported and one unstable angina was documented. Despite the frequency of non-significant atheroma, an acute coronary syndrome exceptionally complicates a "normal" coronarography.
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