The Effect of Noncritical Coronary Artery Disease on Long-Term Survival

Crenshaw, James H.; Sullivan, Jay M.; Ramanathan, Kodangudi B.; Mirvis, David M.; El-Zeky, Faten; Zwaag, Roger Vander

doi:10.1097/00000441-199507000-00005

Cited by 13 publications

(4 citation statements)

References 25 publications

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“…While theoretical considerations and angiographic studies suggest that such plaques are often vulnerable and prone to rupture, 6,[10][11][12] the few studies that have looked into the long-term outcome of patients with INCA had provided conflicting results. [7][8][9] Despite this, the Second Joint Task Force of European and other Societies on Coronary Prevention recommends institution of preventive strategies in patients with occult atherosclerotic lesions in a manner similar to those with established CHD. 5 Additional long-term observational and clinical studies may provide better evidence on the matter and attenuate the confusion that predominates in the appropriate treatment of patients with INCD.…”

Section: Discussionmentioning

confidence: 99%

“…7 The risk for lesion progression and long-term prognosis appears to be related to the presence of the classical risk factors. 8,9 Moreover, angiographic studies have shown that a large proportion of acute coronary events are caused by rupture of plaques that initially obstructed < 50% of the arterial lumen. 10,11 Treatment of such plaques with lipid-lowering agents prevents their progression and reduces the incidence of clinical events.…”

Section: Introductionmentioning

confidence: 99%

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Preventive therapy in patients with insignificantly narrowed coronary arteries: Evaluation of physician attitude and practice

Henkin

Abu‐Ful

Yosefi

et al. 2004

Clinical Cardiology

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SummaryBackground: Although the outcome of patients with angiographically insignificantly narrowed coronary arteries (INCA) is not clearly defined, such lesions can progress or rupture, thus causing cardiovascular morbidity. Preventive therapy with aspirin and lipid-lowering drugs therefore seems warranted in these patients.Hypothesis: The study was undertaken to evaluate the attitude and practice of physicians toward the provision of preventive treatment to patients with INCA.Methods: The attitude of physicians was evaluated using written case histories of three patients with identical clinical features but different angiographic diagnoses. We then examined randomly chosen files of 130 patients with angiographically normal coronary arteries, 130 patients with INCA, and 130 patients with significant coronary artery disease, in relation to the use of lipid-lowering medications and achieved lipoprotein levels.Results: For the hypothetical patients, more physicians prescribed statins (78 vs. 47%, p < 0.0001) and aspirin (89 vs. 74%, p < 0.003) for patients with significant disease than they did for those with INCA. A target low-density lipoprotein (LDL) cholesterol of < 100 mg/dl was considered appropriate for significant disease by 85% of physicians compared with 40% for INCA (p < 0.0001). In the real patients, more of those with significant disease received lipid-lowering drugs and achieved the LDL target level than did those with INCA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preventive therapy in patients with insignificantly narrowed coronary arteries: Evaluation of physician attitude and practice

Henkin

Abu‐Ful

Yosefi

et al. 2004

Clinical Cardiology

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“…Previous studies suggest that patients with documented non-critical lesions on angiogram have progression of disease and higher mortality, while those with normal angiograms reportedly have excellent outcomes. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Unfortunately, selection bias, brief follow-up periods, and small sample sizes prevent the generalizability of these earlier fi ndings.…”

Section: Introductionmentioning

confidence: 99%

Five-year mortality and coronary heart disease development after normal coronary angiogram

2011

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BACKGROUND: Previous studies depict low cardiac event and mortality rates in patients with angiographically normal coronary arteries. These studies, however, are limited by small sample sizes, short follow-up intervals, and selection biases. This study was undertaken to determine the natural five-year course of a diverse cohort of subjects with documented normal coronary arteries with respect to coronary heart disease development, revascularization need, and all-cause mortality. METHODS:Consecutive adult patients with angiographically normal coronary arteries were followed up for 5 years through medical record review. Patients with any degree of angiographic abnormality, including minimal luminal irregularity or non-critical stenosis, were excluded. Patients were not excluded based on age, co-morbidities (except cardiac transplant and structural heart disease), indication for angiogram, or initial hospitalization status. RESULTS:Normal coronary arteries were found in 182 (31.3%) of 582 patients; 129 met all inclusion criteria. The mean age was (49.1±12.5) years; 47 (36.7%) were male and 75 (58.1%) were caucasian. The most common indication for angiography was cumulative risk factors (60.5%). Within 5 years of a normal angiogram, 13 of 129 patients died (10.1%; 95 CI 5.7%-16.9%). Six (40%; 95 CI 19.8% to 64.3%) of 15 patients undergoing repeat angiogram within five years developed new coronary heart disease, with one requiring revascularization. Of traditional risk factors of coronary heart disease, only diabetes was associated with a higher risk of death. CONCLUSION:The natural fi ve-year course of a diverse cohort of patients with documented normal coronary arteries suggests that there is signifi cant risk for death and development of coronary heart disease.

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“…The mechanism of chest pain in this condition is controversial [3]. However, although these patients likely represent a heterogeneous population with different pathophysiological background including both ischemic [4] and nonischemic [5] mechanisms, a favorable long-term prognosis is generally reported [6][7][8][9][10][11][12]. In the Coronary Artery Surgery Study [8], including 4,051 patients, 7-year survival was 96% in case of normal and 92% in case of mildly abnormal (< 50% stenosis) coronary disease.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Noninvasive Stressing Modalities in Patients with Chest Pain and Normal Coronary Angiogram

Bigi

Chiara

2005

Herz

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The Effect of Noncritical Coronary Artery Disease on Long-Term Survival

Cited by 13 publications

References 25 publications

Preventive therapy in patients with insignificantly narrowed coronary arteries: Evaluation of physician attitude and practice

Preventive therapy in patients with insignificantly narrowed coronary arteries: Evaluation of physician attitude and practice

Five-year mortality and coronary heart disease development after normal coronary angiogram

Prognostic Value of Noninvasive Stressing Modalities in Patients with Chest Pain and Normal Coronary Angiogram

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