Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

On the Natural History of Coronary Artery Disease : A Longitudinal Nationwide Serial Angiography Study

Mohammad, Moman A. LU ; Stone, Gregg W. ; Koul, Sasha LU ; Olivecrona, Göran K. LU ; Bergman, Sofia LU ; Persson, Jonas LU ; Engstrøm, Thomas LU ; Fröbert, Ole ; Jernberg, Tomas and Omerovic, Elmir , et al. (2022) In Journal of the American Heart Association 11(21).
Abstract

BACKGROUND: The long-term course of coronary atherosclerosis has not been studied in large nationwide cohorts. Understanding the natural history of coronary atherosclerosis could help identify patients at risk for future coronary events. METHODS AND RESULTS: All coronary artery segments with <50% luminal stenosis in patients with a first-time coronary angio-gram between 1989 and 2017 were identified (n=2 661 245 coronary artery segments in 248 736 patients) and followed until a clinically indicated angiography within 15 years was performed or until death or end of follow-up (April 2018) using SCAAR (Swedish Coronary Angiography and Angioplasty Registry). The stenosis progression and incidence rates were 2.6% and 1.45 (95% CI,... (More)

BACKGROUND: The long-term course of coronary atherosclerosis has not been studied in large nationwide cohorts. Understanding the natural history of coronary atherosclerosis could help identify patients at risk for future coronary events. METHODS AND RESULTS: All coronary artery segments with <50% luminal stenosis in patients with a first-time coronary angio-gram between 1989 and 2017 were identified (n=2 661 245 coronary artery segments in 248 736 patients) and followed until a clinically indicated angiography within 15 years was performed or until death or end of follow-up (April 2018) using SCAAR (Swedish Coronary Angiography and Angioplasty Registry). The stenosis progression and incidence rates were 2.6% and 1.45 (95% CI, 1.43–1.46) per 1000 segment-years, respectively. The greatest progression rate occurred in the proximal and middle segments of the left anterior descending artery. Male sex and diabetes were associated with a 2-fold increase in risk, and nearly 70% of new stenoses occurred in patients with baseline single-vessel disease (hazard ratio, 3.86 [95% CI, 3.69– 4.04]). Coronary artery segments in patients with no baseline risk factors had a progression rate of 0.6% and incidence rate of 0.36 (95% CI, 0.34– 0.39), increasing to 8.1% and 4.01 (95% CI, 3.89– 4.14) per 1000 segment-years, respectively, in patients with ≥4 risk factors. The prognostic impact of risk factors on stenosis progression was greatest in younger patients and women. CONCLUSIONS: Coronary atherosclerosis progressed slowly but more frequently in the left coronary artery in men and in the presence of traditional risk factors. Coronary artery segments in patients without risk factors had little or no risk of stenosis progression, and the relative impact of risk factors appears to be of greater importance in younger patients and women. These findings help in the understanding the long-term course of coronary atherosclerosis.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and , et al. (More)
; ; ; ; ; ; ; ; ; ; ; and (Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
coronary artery disease, ischemic heart disease, natural history
in
Journal of the American Heart Association
volume
11
issue
21
article number
e026396
publisher
Wiley-Blackwell
external identifiers
  • pmid:36300820
  • scopus:85141004541
ISSN
2047-9980
DOI
10.1161/JAHA.122.026396
language
English
LU publication?
yes
id
ba6eb630-85b6-4a6e-b180-1d42e1e75df5
date added to LUP
2022-12-02 13:35:00
date last changed
2024-04-04 06:52:36
@article{ba6eb630-85b6-4a6e-b180-1d42e1e75df5,
  abstract     = {{<p>BACKGROUND: The long-term course of coronary atherosclerosis has not been studied in large nationwide cohorts. Understanding the natural history of coronary atherosclerosis could help identify patients at risk for future coronary events. METHODS AND RESULTS: All coronary artery segments with &lt;50% luminal stenosis in patients with a first-time coronary angio-gram between 1989 and 2017 were identified (n=2 661 245 coronary artery segments in 248 736 patients) and followed until a clinically indicated angiography within 15 years was performed or until death or end of follow-up (April 2018) using SCAAR (Swedish Coronary Angiography and Angioplasty Registry). The stenosis progression and incidence rates were 2.6% and 1.45 (95% CI, 1.43–1.46) per 1000 segment-years, respectively. The greatest progression rate occurred in the proximal and middle segments of the left anterior descending artery. Male sex and diabetes were associated with a 2-fold increase in risk, and nearly 70% of new stenoses occurred in patients with baseline single-vessel disease (hazard ratio, 3.86 [95% CI, 3.69– 4.04]). Coronary artery segments in patients with no baseline risk factors had a progression rate of 0.6% and incidence rate of 0.36 (95% CI, 0.34– 0.39), increasing to 8.1% and 4.01 (95% CI, 3.89– 4.14) per 1000 segment-years, respectively, in patients with ≥4 risk factors. The prognostic impact of risk factors on stenosis progression was greatest in younger patients and women. CONCLUSIONS: Coronary atherosclerosis progressed slowly but more frequently in the left coronary artery in men and in the presence of traditional risk factors. Coronary artery segments in patients without risk factors had little or no risk of stenosis progression, and the relative impact of risk factors appears to be of greater importance in younger patients and women. These findings help in the understanding the long-term course of coronary atherosclerosis.</p>}},
  author       = {{Mohammad, Moman A. and Stone, Gregg W. and Koul, Sasha and Olivecrona, Göran K. and Bergman, Sofia and Persson, Jonas and Engstrøm, Thomas and Fröbert, Ole and Jernberg, Tomas and Omerovic, Elmir and James, Stefan and Bergström, Göran and Erlinge, David}},
  issn         = {{2047-9980}},
  keywords     = {{coronary artery disease; ischemic heart disease; natural history}},
  language     = {{eng}},
  month        = {{11}},
  number       = {{21}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of the American Heart Association}},
  title        = {{On the Natural History of Coronary Artery Disease : A Longitudinal Nationwide Serial Angiography Study}},
  url          = {{http://dx.doi.org/10.1161/JAHA.122.026396}},
  doi          = {{10.1161/JAHA.122.026396}},
  volume       = {{11}},
  year         = {{2022}},
}