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Prognostic implications of angiographically normal and insignificantly narrowed coronary arteries
Insights
Patients with normal or insignificant coronary artery disease (CAD) have excellent survival rates, but many experience persistent symptoms and functional impairment, highlighting the need for ongoing management strategies.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Coronary artery disease (CAD) is a leading cause of mortality and morbidity worldwide.
- The clinical course and long-term prognosis of patients with normal or insignificant CAD are not fully understood.
- Understanding these outcomes is crucial for effective patient management and resource allocation.
Purpose of the Study:
- To examine the clinical presentation and prognosis of a large cohort of patients with normal or insignificant CAD.
- To compare outcomes between patients with normal coronary arteries and those with insignificant CAD.
- To identify factors influencing cardiac events and functional status in this patient population.
Main Methods:
- Retrospective analysis of clinical data from 1,977 consecutive patients.
- Assessment of traditional cardiac risk factors and electrocardiogram (ECG) abnormalities.
- Long-term follow-up to evaluate cardiac survival, myocardial infarction-free survival, and functional status.
Main Results:
- Excellent long-term cardiac survival: 99% at 5 years and 98% at 10 years for patients with normal or insignificant CAD.
- Patients with normal coronary arteries had a higher myocardial infarction-free survival rate compared to those with insignificant CAD.
- A significant relationship was observed between the extent of insignificant CAD and follow-up cardiac events.
- Despite low mortality, a high proportion of patients reported persistent chest discomfort and functional limitations, impacting daily activities.
Conclusions:
- Patients with normal or insignificant coronary artery disease (CAD) demonstrate favorable long-term survival.
- However, a substantial number experience ongoing symptoms and functional impairment, necessitating continued medical attention.
- The degree of coronary artery narrowing, even when below significant thresholds, correlates with adverse cardiac events.
Abstract:
The clinical presentation and prognosis of 1,977 consecutive patients with normal coronary arteries or "insignificant" coronary artery disease (CAD) (no major epicardial artery with 75% or more luminal diameter narrowing) were examined. Compared with patients with significant CAD, these patients had a lower frequency of traditional cardiac risk factors and abnormalities on the rest and exercise electrocardiogram. Cardiac survival was 99% at 5 years of follow-up and 98% at 10 years for patients with normal or insignificantly narrowed coronary arteries. Patients with normal coronary arteries differed from those with insignificant CAD in their myocardial infarction free survival rate: 99% at 5 years and 98% at 10 years for patients with normal coronary arteries, compared with 97% at 5 years and 90% at 10 years for patients with insignificant CAD. A strong relation occurred between the amount of insignificant CAD and follow-up cardiac events (chi 2 = 21.5, p less than 0.0001). Cardiac risk factors were statistically related to the risk of follow-up cardiovascular events when considered alone (chi 2 = 4.93, p = 0.026), but this relation lost significance after adjusting for the effect of coronary anatomy. Patients in both groups continued to have cardiac symptoms that resulted in frequent hospitalizations, medication use and job disability. Almost 50% in any given year of follow-up could not perform activities of high metabolic equivalent requirement and 70% had continuing symptoms of chest discomfort. Although these patients are at low risk of death, many remain functionally impaired for years.