DIFFERENT RATES OF CORONARY-ARTERY DISEASE PROGRESSION IN PATIENTS WITH NORMAL AND MILDLY DISEASED CORONARY-ARTERIES

This study assessed long-term progression of coronary disease in patients with normal coronary angiographic findings and in patients in whom mild atherosclerosis was documented at coronary angiography. Eight-five patients, 44 men and 41 women, with a mean age of 47 +/- 8 years, underwent a second coronary angiogram 70 +/- 31 months (range, 4 to 129) after the initial study. The number of diseased segments was counted in a 27-segment coding system, and progression of coronary artery disease was defined as an increase in stenosis of 30% or greater. Progression was noted in one of 32 patients (3.1%) with normal baseline coronary angiograms and in 39 of 53 patients (73.6%) with mild atherosclerosis (P < 0.0001). Univariate predictors of progression in patients with mild disease were cigarette smoking (P = 0.006), high serum cholesterol (P = 0.04), interim myocardial infarction (P = 0.01), and number of disease segments (P = 0.0001). By multivariate logistic regression, the number of diseased segments was the only independent predictor of progression. Thus, adults with normal coronary angiograms rarely show evidence of new lesions within the first 6 years of follow-up, whereas adults with mild diffuse atherosclerosis experience a relatively high incidence of disease progression during the same period.