Association Between Angina Symptom Characteristics and Obstructive Coronary Artery Disease: A Comparative...

Angina, the primary symptom reported by patients with coronary artery disease (CAD), is an essential consideration in CAD treatment strategies and evaluations of treatment efficacy. However, research exploring the relationship between angina symptom characteristics (severity, type, and frequency) and obstructive CAD is scarce.

This study was designed to investigate the association between obstructive CAD and angina symptom severity, type, and frequency.

A cross-sectional approach was used to analyze baseline data from two studies conducted from March 2018 to September 2021 at a medical center in northern Taiwan. The sample comprised 723 patients undergoing invasive coronary angiography for suspected or known CAD. The participants were categorized into obstructive (≥50% stenosis in at least one epicardial artery) and control groups. Angina symptom severity, type, and frequency were assessed using the Angina Evaluation Form.

The average age of the participants was 60.1 years, and most (83.7%) were male. Nearly three-quarters (73.1%) had Class 1 or 2 angina, 60.3% reported experiencing typical angina, and 46% had angina episodes at least once per week. The results of multiple logistic regression analysis found older age, male sex, history of diabetes, currently smoking, higher low-density lipoprotein levels, lower estimated glomerular filtration rate, and typical angina to be associated with a higher risk of obstructive CAD. Risk of obstructive CAD was twice as high in participants experiencing typical angina symptoms than those experiencing atypical angina symptoms ( OR =1.97, 95% CI=[1.09, 3.54], p =.025). Subgroup analysis findings identified associations to be higher in younger ( OR =2.22, 95% CI=[1.23, 3.99], p =.008) and male ( OR =1.83, 95% CI=[1.08, 3.09], p =.024) participants. Also, the risk of obstructive CAD was higher for those experiencing angina episodes less than twice per week, only in the subgroup of older individuals. No significant relationship between angina symptom severity and risk of obstructive CAD was found.

Angina type, rather than severity or frequency, is significantly associated with obstructive CAD. The findings of this study emphasize the importance of conducting comprehensive angina symptom evaluation in risk assessments on patients with suspected or known CAD. Furthermore, large-scale prospective studies should be conducted in different population groups and settings to validate angina symptoms as a predictor of obstructive CAD.