title: Risk of developing coronary artery disease following a normal coronary angiogram in middle-aged adults.
abstract: Atherosclerosis begins in the teenage years and progresses over time in susceptible individuals. It is unknown, however, whether coronary angiography in middle-aged adults showing no evidence of atherosclerosis identifies individuals at low risk for subsequent development of coronary artery disease (CAD). We identified 4068 patients ≥40 years of age who had at least two coronary angiograms between January 1, 1990 and March 31, 2011. Of these, 227 patients (5.8%) had no CAD and 251 patients (6.4%) had mild atherosclerotic disease (stenosis <30%) on the initial angiogram. Patients in the normal-angiogram group were younger, more often female, and less likely to use tobacco than patients in the mild-atherosclerosis group, while rates of diabetes and hypertension were the same. Angiographic evidence of any CAD and obstructive CAD was apparent in 26% and 4.8%, respectively of the normal-angiogram group on subsequent angiography performed 75 ± 46 months later. Myocardial infarction and revascularization occurred in 4.8% and 3.5%, respectively. Progression of CAD (odds ratio = 10.2), development of obstructive CAD (odds ratio = 8.9), myocardial infarction (odds ratio = 2.7), and revascularization (odds ratio = 8.4) were more frequent in the mild-atherosclerosis group. In summary, 26% of middle-aged adults with a normal coronary angiogram who had subsequent angiography for clinical reasons developed CAD, although the annual rates of myocardial infarction or revascularization were very low. Even mild atherosclerosis on the initial angiogram increased the rate of progression of CAD by 10-fold and the rate of revascularization by 8-fold.
authors.affiliation: Division of Cardiology, University of North Carolina, Chapel Hill, NC 27599-7075 USA. rstouff@med.unc.edu.
authors.forename: Maheswara S G
authors.initials: MS
authors.lastname: Rao Golla
authors.forename: Timir
authors.initials: T
authors.lastname: Paul
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Rao
authors.forename: Chris
authors.initials: C
authors.lastname: Wiesen
authors.forename: Michael
authors.initials: M
authors.lastname: Yeung
authors.forename: George A
authors.initials: GA
authors.lastname: Stouffer
mesh_terms: D000328:Adult; D000367:Age Factors; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy; D009204:Myocardial Revascularization; D016017:Odds Ratio; D012306:Risk; D012737:Sex Factors