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The patient journey in chronic coronary syndromes with/without obstructive coronary arteries
Sarena La1,2,3, Rosanna Tavella1,2,3, Jing Wu1
1School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5000, Australia.
Insights
Patients with angina and no obstructive coronary artery disease (ANOCA) have similar symptoms to those with obstructive coronary artery disease (CAD) but face a significant diagnostic and treatment gap post-angiography.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Patient Outcomes
Background:
- Management pathways for obstructive coronary artery disease (CAD) are established.
- The clinical and diagnostic journey for patients with angina with no obstructive coronary artery disease (ANOCA) is poorly understood due to limited data.
Purpose of the Study:
- To compare the clinical presentation, diagnostic assessment, and 12-month patient-reported outcome measures (PROMs) of patients with ANOCA versus obstructive CAD.
- To evaluate three-year composite Major Adverse Cardiovascular Events (MACE) in ANOCA versus obstructive CAD patients.
Main Methods:
- Utilized data from the Coronary Angiogram Database of South Australia (CADOSA) registry.
- Included 2,285 ANOCA patients and 4,087 obstructive CAD patients between 2012-2018.
- Compared clinical presentation, diagnostic workup, PROMs, and MACE.
Main Results:
- Pre-angiography, ANOCA and obstructive CAD patients had indistinguishable chest pain and ischemic markers.
- ANOCA patients were younger, more likely female, and had fewer cardiac risk factors.
- Post-angiography, ANOCA patients were less likely to receive a cardiac diagnosis or anti-anginal therapy, despite similar persistent angina rates.
Conclusions:
- The pre-angiography clinical presentation and diagnostic markers for ANOCA and obstructive CAD are similar.
- A significant diagnostic and treatment gap exists for ANOCA patients after invasive coronary angiography.
- Addressing this gap is crucial for improving care for ANOCA patients.
Background And Aims:
In patients undergoing invasive coronary angiography for the investigation of angina, the management pathways for obstructive coronary artery disease (CAD) are well described, whereas the clinical and diagnostic journey of patients with Angina with Non-Obstructive Coronary Arteries (ANOCA) has largely been inferred, as there is limited quantitative data. To compare the journey of patients with ANOCA vs. obstructive CAD, particularly in relation to (i) clinical presentation, and (ii) diagnostic assessment, (iii) 12 month patient-reported outcome measures, and (iv) 3-year composite major adverse cardiovascular events.
Methods And Results:
A total of 2285 ANOCA and 4087 obstructive CAD consecutive patients were included from the CADOSA (Coronary Angiogram Database of South Australia) registry between 2012 and 2018. At presentation for elective invasive angiography, the chest pain features and non-invasive ischaemic markers were indistinguishable between patients with obstructive CAD and ANOCA, although the latter were younger (67 ± 11 vs. 61 ± 11 years, P < 0.001), more likely to be female (27 vs. 58%, P < 0.001) and have fewer traditional cardiac risk factors. However, following angiography (compared to those with obstructive CAD), patients with ANOCA were less likely to attain a cardiac discharge diagnosis (100 vs. 22%) or receive anti-anginal therapy (76 vs. 57%), despite the same prevalence of persistent angina (weekly angina: 10 vs. 11% over 12 months).
Conclusion:
Although the pre-angiography journey (symptoms and non-invasive ischaemic investigations) of patients with obstructive CAD and ANOCA is indistinguishable, the post-angiography journey is portrayed by a vast diagnostic and treatment gap in those with ANOCA, which needs to be addressed.
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