Abstract 3869: The Long-Term Prognosis of Mild Coronary Artery Disease: a 10 Year Follow-up Study From The MONICA-BELLUX Registry
Background: Mild coronary disease (CAD) (diameter stenosis less than 50%) at coronary arteriography is generally considered as a benign expression of arteriosclerosis. No long term data are available.
Aim: To assess the long-term outcome (10 years) of mild CAD.
Methods: The MONICA-BELLUX registry allows complete follow-up of the population (age: 35–74 years) of the Belgian province of Luxembourg (target population: 130.000). All fatal and non fatal cardiac events are detected in this public health project according to the MONICA (WHO) protocol. As part of substudy of the main MONICA-BELLUX registry, all invasive diagnostic and therapeutic procedures performed on the target population are monitored since 1985. During the period 1985–1992, 620 patients (age: 55–74 yrs) of the target population underwent their first coronary arteriography with the angiographic diagnosis of smooth vessel (n=287) (Group I); mild CAD (diameter stenosis less than 50%) (n=134) (Group II); significant 1 vessel-disease (diameter stenosis > 50%) not followed by a successful revascularization procedure (n=199) (Group III). Complete 10 year follow-up was available. Mean age was respectively 63.3, 63.9 and 64.8 yrs (NS).
Results: At 10 year follow-up, the combined endpoint (coronary death/non fatal myocardial infarction) had occurred in 66 pts (Group I: 12 pts; Group II: 16 pts; Group III: 48). Event-free survival at 10 years (Kaplan-Meier) was 94.7% in Group I, 86.2% in Group II and 71.7% in Group III (I vs II; II vs III, p < 0.01 by log rank). By multivariate analysis, older age and mild CAD (HR: 2.35) were found to be independent variables predicting the occurrence of fatal and non fatal coronary events.
Conclusion: The normal angiographic appearance of coronary vessels yields excellent long-term prognosis. In contrast, mild coronary arteriosclerosis is associated with an increase of the occurrence of coronary events but the prognosis is still significantly better than in pts with significant 1 vessel-disease. The general assumption that mild CAD bears a benign long-term outcome should be reconsidered and the therapeutic approach should be adapted.