Objectives: Up to 20% of coronary angiograms reveal normal arteries. How long they stay normal is poorly understood. This study investigated the fate of normal coronary arteries and determined the rate of development of coronary artery disease.

Methods: We interrogated the angiographic archive of the South Yorkshire Cardiothoracic Centre between 2004 and 2013 to identify patients with truly normal coronary arteries who underwent repeat coronary angiography more than 1 year later. Follow up angiograms were scored for the severity and extent of CAD (graded per segment as 0%, 1–50%, >50%). Risk factors for the development of coronary artery disease were documented. Univariate predictors of disease development were identified and entered into a logistic regression model to identify independent predictors.