How well does angiographic progression correlate with clinical events?

An understanding of how angiographic progression correlates with events is useful at this time for two reasons. First, to more fully comprehend the contribution of these trials in the past and second, to interpret trials which are currently underway or in the planning stages. A grave disservice has been done to the angiographic trials by introduction of the concept of “small angiographic change” leading to a “large reduction in events”. The former is due solely to the denominator effect and the latter was not generally seen, at lest in terms of the traditional endpoint of death from coronary disease plus non-fatal myocardial infarction. The predictive power of angiographic progression of future clinical events (its ability to serve as a “surrogate”) has been demonstrated during long term follow-up of three major angiographic trials. The success of sequential angiography to serve as a surrogate is probably based on the fact that angiography can detect plaque rupture. Thus angiographic trials could best be referred to as “plaque repture trails”.