Long-Term Follow-Up of Patients with an Initially Normal Coronary Angiogram or Minimal Atherosclerosis at Baseline

The aim of the present study of was to characterize patients with an initially normal (or minimal atherosclerosis) coronary angiography (CA) who underwent repeated CA during follow-up.

Between 2003 and 2015 12,197 patients underwent CA at our hospital. 3166 (26 %) patients (mean age 63.5 years ± 11.7; range 19-92) had normal coronary arteries. Of the initially normal patients, 227 patients (7.2%; 49.8% male, 50.2% female) underwent another CA after 3.7 ± 2.5 years where 159 patients again had normal arteries (mean age 63.8 ± 10.2; 45.9 % male) while 68 had progression to significant coronary artery disease (CAD; mean age 63.0 ± 11; 58.8% male; p=0.05 for sex). The indication for the second CA was a clinical diagnosis of acute myocardial infarction (AMI; STEMI or NSTEMI) in 16/159 (10.1%) patients who still were not having significant CAD. These patients (9 female, 7 male) had the following final diagnoses: stresscardiomyopathy (5), type 2 AMI (5), perimyocarditis (3), early repolarization (1), and unknown (2). Of the 68 patients who had progression to at least one stenosis of ≥ 50% luminal narrowing at their second CA, 36 (53%) were treated with PCI. None of the clinical characteristics, including stress test results and indication, of the 227 patients presenting for a second CAG was predictive for significant CAD at the second CA.

An initially normal CA is significantly more common in females than in males in our cohort of > 12 000 patients. 7.2 % of patients with an initially normal CA undergo at least a second CA during follow-up. Of the patients with progression to CAD a high percentage (53%) had to be treated by PCI. Unfortunately, no clinical parameter was predictive for significant findings at the second CA and thus second CA was hardly to be judged unnecessary.