Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA.
Department of Medicine, University of North Carolina Health System, Chapel Hill, North Carolina, USA.
Clin Cardiol. 2021 Sep;44(9):1286-1295. doi: 10.1002/clc.23686. Epub 2021 Jul 3.
Normal or near normal coronary arteries (NNCA) or nonobstructive coronary artery disease (CAD) are commonly found on invasive coronary angiography (ICA).
We aimed to determine long-term outcomes by severity of CAD in a contemporary cohort of patients undergoing ICA for evaluation for ischemic heart disease.
We assessed a consecutive cohort of 925 patients who underwent non-emergent ICA over 24 months. Cardiac death (CD), nonfatal myocardial infarction (NFMI), late revascularization, and medication use were assessed.
Follow-up data was available in 850 patients. Of patients without heart failure, at a median of 6.0 years, there was a significant decrease in survival free from CD or NFMI, and from all cardiac events, for those with obstructive CAD compared with patients with NNCAs or nonobstructive CAD (p < .001 for both). No differences between NNCA and nonobstructive CAD patients in rates of CD or NFMI (2.0% vs. 2.1%/year, p = .58) or all cardiac events (2.4% vs. 2.9%/year, p = .84) were observed.
Long-term follow-up in a contemporary cohort of consecutive patients undergoing non-emergent ICA for detection of CAD showed no difference in annual rates of CD or NFMI, or total cardiac events, in patients with NNCAs versus those with nonobstructive CAD, whereas patients with obstructive CAD had significantly more events. Event rates were low and similar by gender. Use of aspirin, lipid lowering therapy, and beta-blockers increased in all subgroups after ICA. We speculate this may explain the low incidence of subsequent cardiac events, and similar event rates in patients with NNCA and nonobstructive CAD, even in patients presenting with non-ST-elevation MI.
在经导管冠状动脉造影（ICA）中，常发现正常或近乎正常的冠状动脉（NNCA）或非阻塞性冠状动脉疾病（CAD）。
我们旨在通过对因缺血性心脏病行 ICA 评估的连续患者队列中 CAD 的严重程度来确定长期结局。
我们评估了 24 个月内行非紧急 ICA 的 925 例连续患者队列。评估了心脏性死亡（CD）、非致死性心肌梗死（NFMI）、晚期血运重建和药物使用情况。
在 850 例患者中获得了随访数据。在无心力衰竭的患者中，中位随访时间为 6.0 年，与 NNCA 或非阻塞性 CAD 患者相比，阻塞性 CAD 患者的 CD 或 NFMI 无事件生存率以及所有心脏事件无事件生存率显著降低（均 p<.001）。NNCA 与非阻塞性 CAD 患者的 CD 或 NFMI 发生率（2.0% vs. 2.1%/年，p=.58）或所有心脏事件发生率（2.4% vs. 2.9%/年，p=.84）均无差异。
在因 CAD 检测而行非紧急 ICA 的连续患者连续队列的长期随访中，与非阻塞性 CAD 患者相比，NNCA 患者的 CD 或 NFMI 年发生率或总心脏事件发生率无差异，而阻塞性 CAD 患者的事件发生率明显更高。各亚组患者的性别间事件发生率相似且较低。所有亚组患者在 ICA 后阿司匹林、降脂治疗和β受体阻滞剂的使用率增加。我们推测这可能解释了 NNCA 和非阻塞性 CAD 患者的后续心脏事件发生率低且相似，即使是因非 ST 段抬高型心肌梗死而就诊的患者也是如此。
