32. Incidence and predictors of progression of Coronary Artery Disease among high risk patients with recurrent symptoms

• Main Authors: M. Bassam Bdeir, T. Conboy, I. Farah, A. Habeeb, R. Odeh, A. Alameen, E. Fadel, M. Khateeb, R. Rabai, D. Ali, M Zeineddine, S. Alanzi, M. Mallah
• Format: Article
• Language: English
• Published: Saudi Heart Association 2015-10-01
• Series: Journal of the Saudi Heart Association
• Online Access: http://www.sciencedirect.com/science/article/pii/S1016731515002729

Background: Coronary Artery Disease (CAD) is the leading cause of mortality worldwide. In the current era with highly potent medical therapy, the rate of progression of angiographic CAD is not well described. Thus, the aim of this analysis is to describe the rate and predictors of progression of CAD among patients with recurrent symptoms. Methods: We reviewed 259 patients (Mean age 60;± 11 years, 71% males) who underwent two coronary angiograms between 2008 and 2013. Patients were excluded if they underwent bypass surgery between the two angiograms. Progressive CAD was defined as (A) obstructive CAD in a previously disease-free segment; or (B) new obstruction in a previously non-obstructive segment. Multivariate logistic regression was used to determine the independent predictors of progression of CAD. Results: The mean duration between the two angiograms was 29 ± 13 months. A total of 159 patients (61%) had progression of CAD. Included patients had high prevalence of coronary risk factors (Hypertension 71%, diabetes mellitus 69%, Dyslipidemia 75%). Most patients had controlled dyslipidemia (64% had LDL <70 mg/dl); however, 72% and 40% of patients had glycosylated hemoglobin more than 7% and 8% respectively; 32% of patients had systolic blood pressure more than 140 mmHg. Using multivariate logistic regression, a drop in the left ventricular ejection fraction >5% was the only predictor of CAD progression (adjusted odds ratio 5.8, p = 0.042, 95% CI 1.1–31.2). Conclusions: Among high risk patients with recurrent symptoms, the short term rate of progression of CAD is high. A drop in LVEF >5% is the best predictor of progression of CAD. Further studies are needed to determine the prognostic value of CAD progression in the era of potent medical therapy.