Department of Cardiology, Northern General Hospital, Sheffield, England, United Kingdom; Department of Cardiovascular Sciences, University of Sheffield, Sheffield, England, United Kingdom.
Catheter Cardiovasc Interv. 2015 Feb 15;85(3):401-5. doi: 10.1002/ccd.25589. Epub 2014 Jul 9.
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.
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.
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.
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.
多达 20%的冠状动脉造影显示正常的动脉。人们对其保持正常的时间知之甚少。本研究调查了正常冠状动脉的命运，并确定了冠状动脉疾病的发展速度。
我们在 2004 年至 2013 年间查询了南约克郡心胸中心的血管造影档案，以确定在 1 年以上时间内再次接受冠状动脉造影检查且冠状动脉真正正常的患者。随访的冠状动脉造影按 CAD 的严重程度和范围进行评分（按节段评为 0%、1-50%、>50%）。记录冠心病的危险因素。确定疾病发展的单变量预测因素，并将其输入逻辑回归模型以确定独立的预测因素。
在档案中的 25000 多次血管造影程序中，我们发现 6068 例报告有正常冠状动脉的患者。其中，162 例患者随后进行了重复冠状动脉造影。其中，97 例患者在基线时确实有正常（光滑）的冠状动脉，并在 1 年以上时间后再次进行了血管造影。在中位数为 51 个月时，87 例患者继续保持正常的动脉，其余 10 例患者仅有轻度疾病（平均狭窄 37%，平均 1.2 个节段）。没有患者发生任何明显的（>50%狭窄）疾病。高龄、血管造影时间间隔和吸烟状态被确定为 CAD 发展的独立预测因素。
真正正常的冠状动脉在 4 年内不会进展为严重疾病。在这段时间内，再次进行冠状动脉造影可能是不必要的。
