title: Repeat coronary angiography with previously normal arteries: a futile exercise?
abstract: OBJECTIVE
  Up to 20% of coronary angiograms reveal normal arteries. How long they stay normal is poorly understood. This study investigated the fate of normal coronary arteries and determined the rate of development of coronary artery disease.
  
  
  METHODS
  We interrogated the angiographic archive of the South Yorkshire Cardiothoracic Centre between 2004 and 2013 to identify patients with truly normal coronary arteries who underwent repeat coronary angiography more than 1 year later. Follow up angiograms were scored for the severity and extent of CAD (graded per segment as 0%, 1-50%, >50%). Risk factors for the development of coronary artery disease were documented. Univariate predictors of disease development were identified and entered into a logistic regression model to identify independent predictors.
  
  
  RESULTS
  Out of over 25,000 angiographic procedures in the archives we found 6068 patients reported to have normal coronary arteries. Of these, 162 patients had also undergone subsequent repeat coronary angiography. Of these, 97 had truly normal (smooth) coronary arteries at baseline and had undergone repeat angiography >1 year later. At a median 51 months, 87 continued to have normal arteries, and all the remaining 10 had mild disease only (average 37% stenosis in an average 1.2 segments). No patients developed any significant (>50% stenosis) disease. Advanced age, time between angiograms, and smoking status were identified as independent predictors of development of CAD.
  
  
  CONCLUSIONS
  Truly normal coronary arteries do not progress to significant disease within a time frame of 4 years. Repeat coronary angiography within that period is probably not indicated.
authors: Department of Cardiology, Northern General Hospital, Sheffield, England, United Kingdom; Department of Cardiovascular Sciences, University of Sheffield, Sheffield, England, United Kingdom.
authors: Rebecca
authors: R
authors: Rowe
authors: Yasir
authors: Y
authors: Parviz
authors: Javaid
authors: J
authors: Iqbal
authors: James
authors: J
authors: Heppenstall
authors: Dawn
authors: D
authors: Teare
authors: Julian
authors: J
authors: Gunn
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D018450:Disease Progression; D004739:England; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011873:Radiology Information Systems; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D019564:Unnecessary Procedures
keywords: angiography; coronary artery disease; normal coronary arteries