Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio 670769, USA.
World J Emerg Med. 2011;2(1):24-9. doi: 10.5847/wjem.j.1920-8642.2011.01.004.
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.
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.
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.
The natural five-year course of a diverse cohort of patients with documented normal coronary arteries suggests that there is significant risk for death and development of coronary heart disease.
先前的研究表明,在冠状动脉造影正常的患者中心血管事件和死亡率较低。然而,这些研究受到样本量小、随访时间短和选择偏倚的限制。本研究旨在确定在有记录的正常冠状动脉的不同队列患者中,在五年的自然病程中,冠心病的发展、血运重建的需要和全因死亡率。
连续的冠状动脉造影正常的成年患者通过病历回顾进行了 5 年的随访。排除任何程度的血管造影异常的患者,包括最小管腔不规则或非关键狭窄。患者未根据年龄、合并症(除心脏移植和结构性心脏病外)、造影适应证或初始住院状态进行排除。
在 582 例患者中,有 182 例(31.3%)冠状动脉正常;129 例符合所有纳入标准。平均年龄为(49.1±12.5)岁;47 例(36.7%)为男性,75 例(58.1%)为白人。血管造影最常见的适应证是累积危险因素(60.5%)。在正常血管造影后的 5 年内,129 例患者中有 13 例死亡(10.1%;95%CI 5.7%-16.9%)。在五年内进行重复血管造影的 15 例患者中,有 6 例(40%;95%CI 19.8%至 64.3%)新发生冠心病,其中 1 例需要血运重建。在冠心病的传统危险因素中,只有糖尿病与死亡风险增加相关。
在有记录的正常冠状动脉的不同队列患者的五年自然病程中,死亡和冠心病发展的风险很大。