Abstract 10542: The Utility of Repeat Coronary Angiography in Patients With Non Ischemic Cardiomyopathy

Abstract

Introduction: Up to 20% of angiograms reveal no coronary artery disease (CAD). Repeat studies are often done for chest pain, dyspnea, or reduction in ejection fraction (EF), but little is known about the diagnostic yield of this practice. Methods: Retrospective cohort of patients with no or minimal CAD on their first angiography (<30% stenosis) and a repeat angiography in the last 5 years were included in the study. Results: There were 17 patients with no CAD and 26 patients with mild CAD on initial angiography, with 58 incidences of repeat angiography over an average follow-up of 5.4 years. The average time between procedures was 3.07 ± 1.83 years. Of these, 13 (30.2%) patients had demonstratable progression of CAD, and 8 (18.6%) patients ultimately required PCI. Findings on initial angiogram were associated with CAD progression (p=0.01) but not with intervention requirement (p=0.18), with the odds of new CAD in those with normal coronaries on first angiogram 0.07 (95% C.I. 0.008-0.634, p=0.005). Neither a low EF (<50%) (n=21) nor a drop in EF by >10% (n=17) was associated with CAD progression or PCI. The 8 patients that required PCI presented with STEMI (n=3), NSTEMI (n=3), and unstable angina (n=2). Only one patient with normal coronaries on initial angiography required PCI, after presenting with a STEMI 4 years later and found to have distal LAD thrombotic occlusion with otherwise no coronary atherosclerosis. Conclusions: Repeat angiography had a low yield in our patient population. A drop in EF by >10% was not associated with new findings on repeat angiography or revascularization. Larger studies are needed to investigate if a drop in EF requires invasive testing.