Late Angiographic Follow-Up in Adults With Initial Angiographic Normal or Minimally Narrowed Coronary Arteries

We identified 46 patients with angiographically normal coronary arteries and 16 patients with minor irregularities (luminal narrowing ≤30%) who had repeat coronary angiograms obtained at our institution during the subsequent 15-year period. On follow-up angiograms, 19 of 46 (41%) in the normal coronary group and 13 of 16 (81%) in the minor lesion group showed progression of coronary artery disease (CAD). Five patients (11%) with no angiographic luminal CAD at the time of their baseline angiogram developed an acute myocardial infarction during the follow-up period. Patients in group 1 progressed from no vessels with angiographic lesions to a mean of 0.70 ± 0.90 vessels diseased and a mean angiographic narrowing of 24 ± 34% at the time of their follow-up angiograms, yielding a CAD progression rate of 2.6% luminal narrowing per year. Patients in group 2 had a mean progression of 0.69 ± 0.79% of their vessels and a mean progression in their narrowing of 34 ± 21%, yielding a CAD progression rate of 6.0% luminal narrowing per year. In conclusion, CAD can manifest late, or more likely, many patients with apparently normal coronary arteries have intimal CAD undetectable by angiography.