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Prognostic significance of progression of coronary artery disease
Insights
Coronary artery disease progression impacts survival. Patients with progressing CAD had significantly lower survival rates and higher risks of acute myocardial infarction (AMI).
Area of Science:
- Cardiology
- Clinical Medicine
- Medical Research
Background:
- Coronary artery disease (CAD) is a progressive condition.
- The prognostic impact of CAD progression identified via serial cardiac catheterization is not well-established.
Purpose of the Study:
- To determine the prognostic significance of angiographically documented CAD progression on patient survival and acute myocardial infarction (AMI) events.
Main Methods:
- Follow-up study of 313 patients with CAD undergoing two cardiac catheterizations.
- Analysis of survival and AMI incidence based on the presence or absence of CAD progression between procedures.
- Statistical analysis using log-rank tests and Cox regression.
Main Results:
- CAD progression was observed in 44% of patients.
- Four-year survival was significantly lower in the progression group (83%) compared to the non-progression group (94%).
- Progression was an independent predictor of survival without AMI (relative risk = 2.28).
Conclusions:
- Angiographic progression of coronary artery disease is a significant negative prognostic factor.
- Progression independently predicts adverse outcomes, including reduced survival and increased risk of AMI.
- Ejection fraction and number of diseased vessels remain critical predictors alongside progression.
Abstract:
Angiographically documented coronary artery disease (CAD) can progress. Although progression itself is frequently recognized in patients who have undergone repeat cardiac catheterization, its prognostic significance remains unclear. To evaluate the influence of progression on survival, 313 patients with CAD who underwent catheterization twice (39 +/- 25 months apart) were followed for 3 to 129 months (mean 41 +/- 30) after the second angiogram. At the time of the second angiogram, 21, 91, 113 and 88 patients had 0-, 1-, 2- and 3-vessel CAD, respectively. The mean ejection fraction (EF) of the group was 55 +/- 13%. Progression was noted in 139 patients (44%). Of the 313 patients, 33 died and 39 had acute myocardial infarction (AMI) during follow-up. Four-year survival was estimated at 94% and 83% in the nonprogression and progression groups, respectively. Progression was predictive of survival by (univariate) long-rank test (p less than 0.01), but only EF (p less than 0.001), number of diseased vessels (p less than 0.01) and percent stenosis in the left main coronary artery (p less than 0.05) were independently significant by (multivariate) Cox regression analysis. Four-year survival without AMI was 89% and 73% in the nonprogression and progression groups, respectively. Progression was related to survival without AMI (p less than 0.001) by log-rank test. Cox regression analysis provided 3 independent predictors of survival without AMI: number of diseased vessels (p less than 0.01), progression (p less than 0.01), relative risk = 2.28) and EF (p less than 0.01). Results were similar when analyzing only the 39 AMIs.(ABSTRACT TRUNCATED AT 250 WORDS)