Long‐term outcomes in patients with normal coronary arteries, nonobstructive, or obstructive coronary artery disease on invasive coronary angiography

Abstract

Background Normal or near normal coronary arteries (NNCA) or nonobstructive coronary artery disease (CAD) are commonly found on invasive coronary angiography (ICA). Hypothesis We aimed to determine long‐term outcomes by severity of CAD in a contemporary cohort of patients undergoing ICA for evaluation for ischemic heart disease. Methods We assessed a consecutive cohort of 925 patients who underwent non‐emergent ICA over 24 months. Cardiac death (CD), nonfatal myocardial infarction (NFMI), late revascularization, and medication use were assessed. Results Follow‐up data was available in 850 patients. Of patients without heart failure, at a median of 6.0 years, there was a significant decrease in survival free from CD or NFMI, and from all cardiac events, for those with obstructive CAD compared with patients with NNCAs or nonobstructive CAD (p < .001 for both). No differences between NNCA and nonobstructive CAD patients in rates of CD or NFMI (2.0% vs. 2.1%/year, p = .58) or all cardiac events (2.4% vs. 2.9%/year, p = .84) were observed. Conclusion Long‐term follow‐up in a contemporary cohort of consecutive patients undergoing non‐emergent ICA for detection of CAD showed no difference in annual rates of CD or NFMI, or total cardiac events, in patients with NNCAs versus those with nonobstructive CAD, whereas patients with obstructive CAD had significantly more events. Event rates were low and similar by gender. Use of aspirin, lipid lowering therapy, and beta‐blockers increased in all subgroups after ICA. We speculate this may explain the low incidence of subsequent cardiac events, and similar event rates in patients with NNCA and nonobstructive CAD, even in patients presenting with non‐ST‐elevation MI.

The LDL-C/Apo B predicts coronary atherosclerotic heart disease in non-diabetic patients without high LDL-C

“…Obstructive CAD was defined as at least 1 coronary artery with ≥50% stenosis. [ 13 ] The coronary artery calcium score (CACS) was acquired using the Agatston method with a commercially available reconstruction program for 3-dimensional reconstruction and measurement (Aquarius iNtuition TM Ver.4.4.12 TeraRecon). [ 14 , 15 ] CACS > 0 was defined as detectable coronary artery calcium.…”

Updates in the Management of Coronary Artery Disease: A Review Article

“…Follow-up care is central to managing CAD, allowing healthcare providers to monitor patient progress, address ongoing risk factors, and assess follow-ups. Routine follow-ups promote timely changes in the therapy routine and the execution of safety nets, which can gradually impact personal diagnostic results [ 31 ].…”