Clinical and Angiographic Factors Associated With Coronary Artery Disease Progression of Coronary Artery Disease

Kondo

Circ: Cardiovascular Imaging

et al. 2014

Computed Tomography (AUC2010) does not incorporate prior coronary computed tomographic angiography (CCTA) results in the appropriateness of a CCTA examination. The purpose of this study was to explore the criteria for forgoing repeat CCTA among patients with clinical scenarios suggesting CCTA as appropriate after prior CCTA excluding coronary artery disease. Methods and Results-Among patients from a single center (February 2006 to April 2013) who underwent appropriate CCTA based on AUC2010, consecutive 555 CCTAs, which had a prior CCTA excluding significant stenosis (>50% stenosis in diameter), were selected. The median time difference between the studies was 34.2 (Q1-Q3, 22.9-50.1) months. Significant stenosis was detected at the time of repeat scan (by CCTA or subsequent catheter angiography) in 13.3% (74 of 555). A multivariable logistic model (C-statistic, 0.74; bootstrapped overfitting bias, 0.8%) identified 3 predictors of significant stenosis: time difference between the studies >3 years (adjusted odds ratio, 2.1; 95% confidence interval, 1.2-3.5), diabetes mellitus (odds ratio, 2.4; 95% confidence interval,1.4-4.3), and 26% to 50% stenosis on the initial CCTA (odds ratio, 5.6; 95% confidence interval, 3.2-9.6). When these 3 factors were all absent (corresponding to 31.9% of the population), the probability of significant stenosis was 4.5% (95% confidence interval, 2.7-7.4%), whereas 17.1% of patients had significant stenosis among those with at least 1 positive variable. When coronary arteries were completely normal at the initial scan, the prevalence of significant stenosis was only 1.8% irrespective of other factors, and no patient underwent revascularization. Conclusions-Nondiabetic patients with a prior CCTA <3 years showing no or ≤25% stenosis had a <5% prevalence of significant stenosis.

Section: Discussioncontrasting

confidence: 60%

Repeat Coronary Computed Tomographic Angiography in Patients With a Prior Scan Excluding Significant Stenosis

Kondo

Circ: Cardiovascular Imaging

et al. 2014

“…110 (57) 6 (3.1) 30 (16) 4 (2.1) 35 (18) 7 (3.6) 21 (11) 54 (28) 73 (38) 44 (23) 62.1 +9.6 sample size requirements. In a retrospective analysis"1 of 313 medically treated patients who had two coronary arteriograms at the Montreal Heart Institute, the only two variables available at the first arteriogram that independently predicted progression were younger age and higher extent score.…”

Section: Patient Selectionmentioning

confidence: 99%

A controlled clinical trial to assess the effect of a calcium channel blocker on the progression of coronary atherosclerosis.

et al. 1990

To determine whether calcium channel blockers influence the progression of coronary atherosclerosis, 383 patients age 65 years or less with 5-75% stenoses in at least four coronary artery segments were selected at random within 1 Ninety-two nicardipine patients (55%) and 95 placebo patients (57%) had progression at one or more sites (p=NS). Regression, that is, an improvement by l1o0 or more in diameter stenosis, was seen in 140 of 2,323 lesions (6.0%) overall, with no significant intergroup difference. Among the 217 patients with 411 stenoses of 20% or less in the first study, such minimal lesions progressed in only 15 of 99 nicardipine patients compared with 32 of 118 placebo patients (15% versus 27%, p =0.046). In this subgroup, 16 of 178 minimal lesions in nicardipine patients and 38 of 233 minimal lesions in placebo patients progressed (p=0.038). By stepwise logisticregression analysis, baseline systolic blood pressure (p=0.04) and the change in systolic blood pressure between baseline and 6 months (p=0.002) correlated with progression of minimal lesions. This suggested blood pressure reduction may account for the beneficial action of nicardipine. These results suggested nicardipine has no effect on advanced coronary atherosclerosis but may retard the progression of minimal lesions. (Circulation 1990;82:1940-1953 Several calcium channel blockers have been shown to retard the development of athero-1, sclerosis in rabbits fed cholesterol-rich diets.1-7 The mechanism through which these drugs exert their antiatherogenic effects is not known, but is being From the

“…"Extent score" is defined as the number of segments in a 15-segment coding system with 5% to 75% diameter stenoses. 13 In a series of patients who underwent two coronary arteriograms at our institute and were analyzed retrospectively, a high extent score at the first study correlated with coronary disease progression'3 and new total occlusions. 14 Progression of coronary disease was associated with a higher prevalence of unstable angina at the time of the second angiogram'5 and a higher incidence of subsequent mortality and infarction.…”

mentioning

confidence: 99%

Long-term prognosis of patients with variant angina.

et al. 1987

The long-term prognosis of variant angina and the factors influencing it were assessed in 217 consecutive patients hospitalized in our coronary care unit and followed for a mean of 65 months (range 2 to 123). Cardiac death occurred in 30 patients and an additional 54 experienced a nonfatal myocardial infarction. Survival at 1 and 5 years was 95% and 89%, respectively; survival without infarction was 83% and 69%. Coronary disease and the degree of disease activity were strong predictors of survival by Cox analysis. Survival at 1 year was 99%, and that at 5 years was 95% and 94%, respectively, for patients with one-vessel disease (n = 81) and for those without stenoses of 70% or greater (n = 87). Survival at 1 and 5 years was only 87% and 77% for those with multivessel disease (n = 40 990-997, 1987. CORONARY ARTERY SPASM accounts for the clinical manifestations of variant angina but probably does not play a major role in most patients with other coronary syndromes. Therefore, the long-term outcome of patients with variant angina and the factors influencing their prognosis may differ from those for other patients with coronary disease.The follow-up of four large series of patients with variant angina has been reported. -4 In one of these studies we described 169 such patients followed for a mean of 15 months.2 Angina disappeared spontaneously in many patients after 1 year, particularly those with coexisting organic stenoses. The purpose of this report is to describe the prognosis, and the factors influencing prognosis, in a larger series of 217 patients followed prospectively for a mean of 65 months. MethodsPatients. The diagnosis of variant angina was made in patients meeting all the following criteria: (1) buming or squeezing retrosternal chest pain at rest, (2) relief of the pain by nitroglycerin in less than 5 min, (3) ST segment elevation of at least 2 mm not present on the baseline electrocardiogram but documented during pain and disappearing with relief of pain, and (4) no subsequent evidence of myocardial necrosis. Between April 1976 and April 1986, 217 patients meeting these criteria were hospitalized at the Montreal Heart Institute.The mean age of the patients was 51 years (range 24 to 71); 165 were men and 52 were women. ST segment elevation was noted at the anterior electrocardiographic leads in 112 patients and at the inferior leads in 105 patients. In 161 cases transient ST elevation was detected during resting angina and in the remaining 56 it was documented only after administration of ergonovine.Patient management. Patients were hospitalized in the coronary care unit, where they underwent continuous electrocardiographic monitoring for at least 3 days. A complete electrocardiogram was recorded during episodes of angina at rest when possible. Coronary arteriography was performed by a percutaneous transfemoral approach by use of preformed catheters with routine filming of sagitally angulated views of the left coronary artery. Patients were not routinely given nitroglycerin before angiog...