Is progression of coronary artery disease occurring at bouts or as a continuous process? Serial cineangiographic studies in 44 patients
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Coronary artery disease progression may occur continuously rather than in sudden bursts. Analysis of patient angiograms suggests that disease advancement often happens slowly over several years.
Area of Science:
- Cardiology
- Medical Imaging
- Biostatistics
Background:
- Coronary artery disease (CAD) is a leading cause of mortality worldwide.
- Understanding the temporal pattern of CAD progression is crucial for effective management.
- Previous studies have debated whether CAD progresses continuously or in discrete episodes.
Purpose of the Study:
- To investigate whether coronary artery disease progression occurs as a slow, continuous process or in distinct bouts.
- To analyze the patterns of CAD progression using serial coronary angiograms.
Main Methods:
- Review of coronary angiograms from 44 patients who underwent three catheterizations.
- Application of a logistic regression model incorporating time intervals, age, unstable angina, and CAD extent score.
- Comparison of observed versus expected progression rates between the second and third angiograms in predefined patient groups.
Main Results:
- Patients without progression between the first and second angiograms showed observed progression aligning with expected rates.
- Patients with documented progression between the first and second angiograms exhibited a higher-than-expected frequency of progression between the second and third angiograms (p = 0.068).
Conclusions:
- The findings suggest that coronary artery disease progression is often a continuous process over several years.
- This continuous progression pattern may be more pronounced in patients who have already experienced earlier disease advancement.
Abstract:
In order to assess if coronary artery disease progression occurs as a slow, continuous process or at bouts, the coronary angiograms of 44 patients catheterized three times were reviewed. A previously developed logistic model, taking into account time interval between the angiograms, age, occurrence of unstable angina, and extent score of coronary artery disease, was used to compute a probability of progression from the second to the third angiogram. Two groups of patients were considered: those with (n = 15) and those without (n = 29) progression from the first to the second angiogram (PROGRESSION 1-2). A simulation provided in each group the distribution of the expected number of patients with progression from the second to the third catheterization. In the group without PROGRESSION 1-2, the observed number of progressions from the second to the third angiogram was in agreement with the expected one. However, in the group with PROGRESSION 1-2, the progression from the second to the third angiogram was more frequent than expected (p = 0.068). These results suggest that, in many patients, coronary artery disease progression is continuous over several years.