scholarly journals Long‐term outcomes in patients with normal coronary arteries, nonobstructive, or obstructive coronary artery disease on invasive coronary angiography

2021 ◽  
Author(s):  
Christopher A. Hanson ◽  
Edwin Lu ◽  
Saad S. Ghumman ◽  
Michelle L. Ouellette ◽  
Adrián I. Löffler ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Invasive Coronary Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Long Term Outcomes ◽  
Normal Coronary Arteries ◽  
Artery Disease

Abstract 13804: Clinical Profile and Outcomes of Myocardial Infarction With Non-obstructive Coronary Arteries in Older Adults

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ara H Rostomian ◽  
Derek Q Phan ◽  
Mingsum Lee ◽  
Ray X Zadegan
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Los Angeles ◽  
Coronary Arteries ◽  
Medical Center ◽  
Invasive Coronary Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Kaiser Permanente ◽  
Artery Disease

Introduction: Myocardial Infarction with non-obstructive coronary artery disease (MINOCA) is found in 5%-6% of patients with acute myocardial infarction (AMI). As such, the diagnosis and management of AMI patients with non-obstructive coronary artery disease (NOCAD) poses a challenge as compared to patients with MI with coronary artery disease (MICAD). Hypothesis: To evaluate the characteristics and outcomes of MINOCA in older patients as compared with MICAD patients, with and without revascularization. Methods: This was a retrospective observational study of patients ≥80 years old who underwent invasive coronary angiography (ICA) for AMI between 2009-2019 at Kaiser Permanente Los Angeles Medical Center. MINOCA was defied as <50% stenosis of coronary arteries on angiography with a troponin level ≥0.05 ng/ml. Patients with MINOCA vs MICAD were compared. Multivariate logistic regression was used to identify independent predictors of MINOCA and Kaplan-Meier survival analysis was used to analyze all-cause mortality between cohorts. Results: A total of 259 patients with MINOCA (mean ± SD age 83.8±2.7 years, 68% female) and 687 patients with MICAD (84.7±3.4 years, 40% female) were analyzed. Younger age (odds ratio [OR]=1.11; 95% confidence interval [CI]=1.05-1.18), female sex (OR=3.14; CI=2.20-4.48), black race (OR=2.53; CI=1.61-3.98), no history of prior stroke (OR=1.56; CI=1.06-2.33), atrial fibrillation or flutter (OR=2.04; CI:1.38-3.02), lower troponin levels (OR=1.08; CI:1.03-1.11), and lower triglyceride levels per 10 mg/dl increments (OR=1.06; CI:1.03-1.11) increased the odds of having MINCOA as compared to MICAD. At median follow-up of 2.4 years, MINOCA was associated with a lower rate of death (44.8% vs 55.2%, p<0.01) compared to un-revascularized MICAD, but no difference (31.3% vs 40.4%, p=0.68) when compared to re-vascularized MICAD. Conclusions: Patients age ≥80 years with MINOCA have fewer traditional risk factors compared to their counterparts with MICAD and fewer deaths compared to un-revascularized MICAD, but similar mortality compared to revascularized MICAD

Abstract 19638: A High Percentage of Patients Referred for Invasive Coronary Angiography Found to Have No Obstructive Coronary Artery Disease are Referred for Appropriate Indications

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Michelle Ouellette ◽  
Virginia Workman ◽  
Adrian Loffler ◽  
George A Beller ◽  
Jamieson M Bourque
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Stress Test ◽  
Invasive Coronary Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Coronary Syndrome ◽  
Obstructive Disease ◽  
Number Of Patients ◽  
Artery Disease

Introduction: The incidence of normal coronary arteries in patients referred for invasive coronary angiography (ICA) ranges from 30-60%. We sought to evaluate patterns of referral, assess the rate of appropriate catheterization and determine the prevalence of coronary artery disease (CAD) in our population by appropriateness and indication. Methods: Retrospective analysis was performed on 930 consecutive patients undergoing diagnostic ICA. Indications for ICA were reviewed and appropriate use criteria (AUC) were applied to the cohort retrospectively. Patients with known CAD, prior MI, CHF, or indication for pre-transplant workup or cardiac surgery were excluded. Rates of non-obstructive (21-49% stenosis) and obstructive CAD (≥50%) were compared by appropriateness status using Fisher’s Exact Testing. Results: Of the 930 patients studied, 55.6% were male with median age of 62 and 10-year ASCVD risk score of 17.7%. Acute coronary syndrome (ACS) was the most prevalent indication for referral (48.5%) with a 68.6% prevalence of obstructive CAD. A positive stress test was the indication in 18.9% with a 51.4% rate of obstructive CAD. The rates of the remaining referral indications are given in Figure 1. In those referred appropriately for angiography (n=923), the prevalence of obstructive disease was 55.9% (n=516), non-obstructive disease 13.6% (n=125), and normal coronaries 30.6%(n=282). Inappropriate referral was identified in only 7 patients (0.8%), all of whom had normal coronaries with p<0.001. Conclusions: At a single quaternary care academic center the majority of coronary angiographies performed invasively are appropriate by AUC. Despite adherence to AUC, there continues to be a large number of patients with no evidence of obstructive disease, including in those with ACS. Further research is needed to further refine the AUC and its role in risk stratification for obstructive CAD.

scholarly journals SEX DIFFERENCES IN LONG-TERM OUTCOMES OF PATIENTS WITH NON-OBSTRUCTIVE CORONARY ARTERY DISEASE

2016 ◽  
Vol 67 (13) ◽  
pp. 1860
Author(s):  
Neha J. Pagidipati ◽  
Daniel Mudrick ◽  
Karen Chiswell ◽  
Amanda Brucker ◽  
Michael Mackenzie ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Sex Differences ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Long Term Outcomes ◽  
Artery Disease

Abstract 16357: Identification of Circulating Proteins that Predict the Presence of Obstructive Coronary Artery Disease in Symptomatic, Non-Diabetic Patients Referred for Invasive Coronary Angiography

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
James Wingrove ◽  
Karen Fitch ◽  
Phil Beineke ◽  
Steven Rosenberg
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Invasive Coronary Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Diabetic Patients ◽  
Protein Markers ◽  
Adjusted Analysis ◽  
Major Coronary Artery ◽  
Artery Disease

Background: The diagnosis of patients presenting for the first time with typical or atypical symptoms consistent with obstructive coronary artery disease (CAD) remains challenging; despite the existence of a number of non-invasive modalities for the assessment of CAD, the yield of obstructive CAD in patients who undergo invasive coronary angiography remains low. We sought to identify circulating protein biomarkers that might aid in the diagnosis of obstructive CAD in non-diabetic patients. Methods: 386 non-diabetic patients from the PREDICT study (NCT00500617) were divided into two independent case:control sets for initial marker discovery (Set 1, n=187) and preliminary model validation (Set 2, n=199). Cases were defined as patients with ≥50% stenosis in ≥1 major coronary artery; controls had < 50% stenosis in any major coronary artery as determined by quantitative coronary angiography (QCA). In 11% of the patients QCA was not available and 70% stenosis by clinical read was used as a case threshold. 135 protein markers were evaluated in plasma from Set 1 patients using an electrochemoluminescence-based platform (MesoScale); the top markers were analyzed in Set 2 and used to develop predictive models using penalized logistic regression (LASSO). Model performance was estimated via 2500 iteration of cross validation on random holdout sets of 14 patients. Results: In a sex and age adjusted analysis, nine protein markers obtained nominal significance (p < 0.05) in Set 1, with 9 additional markers trending towards significance (p 0.7); the average of these pairs was used for subsequent analysis. Top markers were evaluated in Set 2 and a five marker (Adiponectin, ApoA1, NT-proBNP, S100A8-MPO, PlGF) model was fitted via LASSO, resulting in a mean cross-validated AUC of 0.64. Conclusion: We have identified a set of plasma protein markers in subjects referred for invasive angiography, which in age and sex adjusted analysis are responsive to the presence of obstructive CAD. Use of such protein markers alone, or in combination with other genomic markers or clinical risk factors may aid in the identification of obstructive CAD in non-acute, symptomatic patients.

scholarly journals Management of ischaemia with non-obstructive coronary arteries (INOCA)

BMJ ◽  
2021 ◽  
pp. e060602
Author(s):  
John F Beltrame ◽  
Rosanna Tavella ◽  
Dione Jones ◽  
Chris Zeitz
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Obstructive Coronary Artery Disease ◽  
Personalised Medicine ◽  
Future Research ◽  
Comprehensive Review ◽  
Artery Disease

Abstract Up to half of patients undergoing elective coronary angiography for the investigation of chest pain do not present with evidence of obstructive coronary artery disease. These patients are often discharged with a diagnosis of non-cardiac chest pain, yet many could have an ischaemic basis for their symptoms. This type of ischaemic chest pain in the absence of obstructive coronary artery disease is referred to as INOCA (ischaemia with non-obstructive coronary arteries). This comprehensive review of INOCA management looks at why these patients require treatment, who requires treatment based on diagnostic evaluation, what clinical treatment targets should be considered, how to treat patients using a personalised medicine approach, when to initiate treatment, and where future research is progressing.

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