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Predictors of Non-Obstructive Coronary Artery Disease in Patients Undergoing Elective Coronary Angiography
Ghazal Peerwani1, Saba Aijaz1,2, Sana Sheikh1
1Department of Clinical Research Cardiology, Tabba Heart Institute, Karachi, Pakistan.
Insights
About 24% of patients undergoing elective coronary angiography had non-obstructive coronaries. Optimizing non-invasive testing selection, especially for younger women and heart failure patients, can improve diagnostic yield.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Appropriate patient selection for coronary angiography (CAG) is crucial to minimize risks associated with the procedure, particularly in low-to-middle-income countries.
- Identifying predictors of non-obstructive coronaries (NOC) can help refine patient selection criteria and reduce unnecessary invasive procedures.
Purpose of the Study:
- To determine predictors of non-obstructive coronaries (NOC) in patients undergoing elective coronary angiography (CAG).
- To identify patient subgroups who are more likely to have non-obstructive coronary artery disease despite undergoing elective CAG.
Main Methods:
- Retrospective analysis of 2,984 patients undergoing elective CAG from the CathPCI Registry® over eight years.
- Non-obstructive coronaries (NOC) defined as <50% stenosis in the left main coronary artery or major epicardial vessels.
- Multiple Cox proportional hazards models were used to identify predictors of NOC.
Main Results:
- 24% of patients undergoing elective CAG had NOC.
- Predictors of NOC included younger age (<50 years), female sex, low/intermediate risk stratification on Modified Framingham Risk Score, and inappropriate/uncertain classification on Appropriate Use Criteria.
- Patients with heart failure as an indication for CAG and those with no or low-risk non-invasive testing were more likely to have NOC.
Conclusions:
- Approximately one in four patients undergoing elective CAG have non-obstructive coronaries.
- Improving the adjudication of non-invasive testing, particularly for specific patient groups, can enhance the diagnostic yield of CAG.
Background:
Appropriate patient selection for coronary angiography (CAG) is essential to minimize the unnecessary risk of morbidities and exposure to radiation and iodinated contrast. This becomes even more relevant in low-to-middle-income settings where most health expenditures are out-of-pocket due to lack of medical insurance. We determined predictors of non-obstructive coronaries (NOC) in patients undergoing elective CAG.
Methods:
CathPCI Registry®, single-center data was extracted for 25,472 patients who had CAG over an eight year period. After excluding patients for compelling conditions or known CAD, 2,984 (11.7%) patients were included in this study. Non-Obstructive Coronaries was defined as <50% left main coronary artery and major epicardial vessel stenosis. Multiple Cox proportional algorithm was employed to report prevalence ratios (PR) of predictors of NOC along with 95% confidence interval.
Results:
Mean age of patients was 57.9 ± 9.7 years, 23.5% were women. Preprocedural non-invasive testing (NIT) was performed in 46% of the patients; of which 95.5% reported to be positive but only 67.3% were stratified as high risk. Of 2,984 patients undergoing elective CAG, 711 (24%) had NOC. Predictors of NOC included younger age <50 years (PR: 1.3, CI: 1.0-1.5), Women (1.8, 1.5-2.1), low (1.9, 1.5-2.5) and intermediate risk stratification (1.3, 1.0-1.6) on Modified Framingham Risk Score and inappropriate (2.7, 1.6-4.3) and uncertain (1.3, 1.1-1.6) classification of CAG on Appropriate Use Criteria. Patients with heart failure as an indication of CAG (1.7, 1.4-2.0) and No NIT or positive low risk NIT (1.8, 1.5-2.2) were more likely to have NOC.
Conclusion:
Approximately one out of four patients undergoing elective CAG had NOC. Yield of diagnostic catheterization can be improved by adjudicating NIT especially in younger patients, women, patients with heart failure as an indication of CAG, patients classified as inappropriate on Appropriate Use Criteria and patients categorized as low or intermediate risk on MFRS.
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