Predictors of significant progression of coronary artery disease
█ Original article
Czakó Balázs, Baranyai Tamás, Ahres Abdelkrim, Őze Ágnes, Rubóczky Gábor, Nagybaczoni Béla, Andrássy Péter
Bajcsy-Zsilinszky Kórház és Rendelőintézet, IV. sz. Belgyógyászati-Kardiológiai Osztály, Budapest
Background: In patients with suspected coronary artery disease, validated pre-test probability models help the clinician’s decision-making, based on simple patient and symptom characteristics. For patients with history of definitive coronary artery disease similar pre-test probability evaluation is not available. In our retrospective analysis, we sought to investigate the predictors of significant progression of coronary artery disease (de novo significant native coronary lesion and/or de novo significant in stent restenosis) in patients with history of obstructive coronary artery disease validated by previous angiogram.
Methods: Consecutive 212 patients, referred for repeated elective coronary angiography, were involved (38% woman, age 64±10 years). Exclusion criteria were: scheduled coronary intervention or fractional flow reserve measurement based on previous angiogram, acute coronary syndrome. Characteristics of symptoms, indications, medical history, results of non-invasive tests, parameters of echocardiography, electrocardiography, previous coronary angiograms and interventions were assessed.
Results: Progression was found in 59% of the patients (64% native coronary lesion, 20% in stent restenosis, 16% both). Among the investigated variables, the strongest predictors are the followings: time since the last myocardial infarction, time since the last coronary angiography, time since the last coronary intervention, typical, or atypical chest pain, no drug-eluting stent in coronary arteries, regional wall motion abnormality, any kind of chest pain, use of bare metal stent at the last intervention.
Conclusion: Our results may help to create pre-test probability models in the future, to predict significant progression of coronary artery disease to facilitate the decision-making between invasive and non-invasive approach.