Special subsets of angiographically defined patients: Normal coronary arteries, single-vessel disease, left main coronary artery disease, patients undergoing coronary revascularization

Abstract

In patients undergoing coronary angiography for investigation of chest pain, the incidence of normal or near-normal coronary arteriographic findings varies between 10 and 20 % [1]. In general, patients without significant epicardial coronary artery disease have an excellent prognosis, but not all nonsignificant stenoses are created prognostically equal, since coronary events are rare in patients with smooth, normal arteriograms, sixfold more frequent in patients with mild (0–20 % stenosis), and 15-fold more frequent in patients with moderate (20–40 %, and still nonsignificant) lesions [2]. Even with most conservative reading criteria, stress echocardiography positivity occurs in 10–20 % of patients with angiographically nonsignificant coronary artery disease [3]. The presence of minor, nonsignificant coronary angiographic abnormalities is four times more frequent in patients with an abnormal stress echocardiogram than in patients with a normal one [3]. At long-term (9 years) follow-up, hard events are ten times more frequent in patients with positive stress echocardiographic results than in those with negative stress echocardiographic results [4] (Fig 27.1, left panel). Within the lower-risk subset of patients with negative stress echo by wall motion criteria, the risk is higher in patients with reduced coronary flow reserve assessed with flowmetry of the left anterior descending coronary artery [5] (Fig. 27.1, right panel).