EVOLUTION OF CORONARY ATHEROSCLEROSIS IN PATIENTS WITH MILD CORONARY-ARTERY DISEASE STUDIED BY SERIAL QUANTITATIVE CORONARY ANGIOGRAPHY AT 2-YEAR AND 4-YEAR FOLLOW-UP

Aims Angiographic studies on the natural course of both and diffuse co ronary atherosclerosis have not been performed before, but can both be assessed by quantitative coronary angiography. The objective of this study was to describe the natural course of focal and diffuse coronary atherosclerosis over time. Methods and results In 129 patients with m ild coronary artery disease, but not on lipid-lowering medication, thr ee coronary angiograms were made each 2 years apart. Nine hundred and sixty five angiographically diseased and non-diseased segments were an alysed by quantitative coronary angiography. Mean lumen diameter and m inimal lumen diameter were used as measures of diffuse and focal coron ary atherosclerosis. Mean lumen diameter and minimum lumen diameter de creased by 0.02 and 0.03 mm per year. The rate of progresssion was sim ilar in the angiographically non-diseased, as in the mildly and modera tely diseased segments. Progression of diffuse coronary atherosclerosi s was largest in severely stenosed lesions (percentage diameter stenos is greater than or equal to 50%) and in the right coronary artery with a loss of 0.19 mm and 0.16 mm in mean lumen diameter. Progression of focal disease was most prominent in new and mild lesions and the right coronary artery, with a decrease in minimum lumen diameter of 0.34 mm and 0.22 mm. In most subgroups, progression occurred gradually over t ime. On a per segment level, progression and the occurrence of new les ions occurred in 44% and 4.2%. Regression and disappearance of a lesio ns was found in 2.3% and 1.9%. On a per patient level, 36% were progre ssors, 12% had a mixed response, 36% were stable, and 16% were regress ors. Conclusion Diffuse and focal coronary atherosclerosis progressed at the same rate in the first and second 2 years in stenosed and non-s tenosed segments. The rate of coronary atherosclerosis progression was small, but was higher for focal than for diffuse disease. A minority of lesions progressed and spontaneous regression was rare.