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Predictors of Coronary Artery Disease Progression among High-risk Patients with Recurrent Symptoms
Iyad Farah1, Amjad M Ahmed1, Raed Odeh1
1King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia.
Insights
Coronary artery disease (CAD) progresses rapidly in high-risk patients despite treatment. A significant drop in left ventricular ejection fraction (LVEF) predicts this progression, highlighting the need for further research.
Area of Science:
- Cardiology
- Vascular Medicine
- Medical Diagnostics
Background:
- The progression rate of angiographic coronary artery disease (CAD) remains unclear despite advanced therapies.
- Understanding CAD progression is crucial for managing patients with recurrent symptoms.
Purpose of the Study:
- To determine the rate and predictors of CAD progression in patients experiencing recurrent symptoms.
- To evaluate the impact of medical therapy on CAD progression.
Main Methods:
- Analysis of 259 patients who underwent two coronary angiograms between 2008 and 2013.
- Definition of progressive CAD included new obstructive lesions or worsening of non-obstructive lesions.
- Multivariate logistic regression identified independent predictors of CAD progression, excluding patients who had bypass surgery.
Main Results:
- The study cohort exhibited high rates of hypertension (71%), diabetes (69%), and dyslipidemia (75%).
- Despite optimal medical management, 61% of patients showed evidence of CAD progression.
- A decrease in left ventricular ejection fraction (LVEF) exceeding 5% was a significant predictor of CAD progression (aOR 5.8, P=0.042).
Conclusions:
- Short-term progression of CAD is common in high-risk patients with recurrent symptoms.
- A decline in LVEF >5% serves as a key predictor for CAD progression.
- Further investigation is required to establish the prognostic significance of CAD progression with current potent medical therapies.
Background:
Despite the availability of new potent medical therapies, the rate of progression of angiographic coronary artery disease (CAD) is not well described. The aim of this analysis is to describe the rate and predictors of progression of CAD among patients with recurrent symptoms.
Materials And Methods:
We reviewed 259 patients (mean age 61 ± 11 years, 70% males) who underwent two coronary angiograms between 2008 and 2013. Progressive CAD was defined as obstructive CAD in a previously disease-free segment or new obstruction in a previously nonobstructive segment. Patients who had coronary artery bypass surgery between these two angiograms were excluded from the analysis. Multivariate logistic regression was used to determine the independent predictors of progression of CAD.
Results:
The included cohort had a high prevalence of coronary risk factors; hypertension (71%), diabetes (69%), and dyslipidemia (75%). Despite adequate medical therapy, more than half of the patients (61%) had CAD progression. Using multivariate logistic regression, a drop in the left ventricular ejection fraction (LVEF) by more than 5% was the predictor of CAD progression (adjusted odds ratio 5.8, P = 0.042, 95% confidence interval 1.1-31.2).
Conclusion:
Among high-risk patients with recurrent symptoms, the short-term rate of progression of CAD is high. A drop in LVEF >5% is a predictor of CAD progression. Further studies are needed to determine the prognostic value of CAD progression in the era of potent medical therapy.
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