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Published on: August 9, 2024
Natural history of patients with insignificant coronary artery disease
Rosanna Tavella1,2, Natalie Cutri2, Graeme Tucker2,3
1Cardiology Unit, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia.
Insights
Patients with insignificant coronary artery disease (ICAD) often experience residual chest pain and reduced quality of life 12 months after angiography. Further management strategies are needed to improve health outcomes for these individuals.
Area of Science:
- Cardiology
- Health Outcomes Research
Background:
- Coronary angiography is performed for chest pain, but outcomes for patients with insignificant coronary artery disease (ICAD) are not well understood.
- Approximately 30% of patients undergoing coronary angiography have ICAD, a condition where coronary stenosis is less than 50%.
Purpose of the Study:
- To compare the health status of patients with ICAD to those with significant coronary artery disease (CAD) and a healthy control group 12 months post-angiography.
- To evaluate health-related quality of life (HRQoL) in patients with ICAD.
Main Methods:
- A cross-sectional, longitudinal study comparing patients with ICAD, CAD (coronary stenosis ≥50%), and a healthy control cohort.
- Data on clinical status and HRQoL were collected at baseline and at 1, 6, and 12 months post-angiography.
Main Results:
- Among 758 patients, 253 (33%) had ICAD. ICAD patients were younger, more often female, and had fewer cardiac risk factors than CAD patients.
- At 12 months, 48% of ICAD patients and 59% of CAD patients were chest pain-free. Both groups reported similar physical component summary scores.
- Both ICAD and CAD patients had significantly lower physical component summary scores compared to healthy controls at 12 months.
Conclusions:
- Patients with ICAD often experience persistent chest pain and impaired HRQoL 12 months after coronary angiography.
- Despite having no significant coronary artery disease, ICAD patients' health status is poorer than that of healthy individuals.
- Novel management strategies are required to enhance health outcomes for patients diagnosed with ICAD.
Aims:
Approximately 30% of patients undergoing coronary angiography for chest pain have insignificant coronary artery disease (ICAD). The subsequent health status of these patients is largely unknown. The current study was a cross-sectional, longitudinal comparison of health status outcomes 12 months following angiography, in a cohort of patients with stable chest pain and ICAD to: (i) patients with significant coronary artery disease (CAD) and (ii) a healthy control cohort.
Methods And Results:
Patients undergoing elective angiography for chest pain were recruited and classified as CAD (coronary stenosis ≥50%) or ICAD. Clinical and health-related quality-of-life (HRQoL) data were collected at baseline, 1, 6, and 12 months following angiography. The 12-month health status was cross-sectionally compared with a healthy control group recruited from the same geographic zone. Among 758 patients undergoing coronary angiography, 253 (33%) had ICAD. Insignificant coronary artery disease patients were younger, more often female, and had less cardiac risk factors than CAD patients. At 12 months, 48% of ICAD and 59% of CAD patients were chest pain-free, and both groups had similar Short-Form 36 Physical Component Summary (PCS) scores (41 ± 11 vs. 41 ± 11 for ICAD and CAD patients, respectively, P > 0.05). However, at 12 months, both the ICAD and CAD patients had significantly lower PCS scores compared with healthy controls (41 ± 11 vs. 49 ± 11, P < 0.05 for both CAD and ICAD).
Conclusion:
Although ICAD patients are frequently considered 'normal' from a cardiac perspective, they often have residual chest pain and impaired HRQoL at 12 months. Novel strategies are needed to manage ICAD patients to improve health outcomes.
Clinical Trial Registration:
This study was registered with the Australian New Zealand Clinical Trials Registry (www.anzctr.org.au, trial identifier ACTRN12610000801011).
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