scholarly journals Angina in Patients with Non-obstructive Coronary Angiograms: Six-years Follow-up

2017 ◽  
Vol 11 ◽  
Author(s):  
Sergio Vancheri ◽  
Viviana Milino ◽  
Michael Henein ◽  
Corrado Tamburino
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Stable Angina ◽  
Obstructive Coronary Artery Disease ◽  
Significant Proportion ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Increased Risk ◽  
Coronary Angiograms

<p><span style="font-family: Calibri;"><strong>Background and Aim: </strong>About one third of patients undergoing coronary angiography for angina have non-obstructive coronary artery disease (CAD). Until recent years the prognosis has been thought to be favourable and no treatment were recommended. More recently, an increased risk of cardiovascular (CV) events has been documented in these patients compared with a general population. We aimed to evaluate the long term persistence of angina and the occurrence of major CV events in patients with stable angina and non-obstructive CAD.</span></p><p><span style="font-family: Calibri;"><strong>Methods: </strong>We retrospectively evaluated all patients with effort angina referred to the cardiac catheterization  laboratory of the Cardiovascular Unit, University of Catania, Sicily, between 1<sup>st</sup> July 2008 and 31<sup>st</sup> December 2009, because of a clinical suspicion of myocardial ischemia, without obstructive CAD, defined as &lt;50% stenosis of left main stem or &lt;70% in any epicardial coronary artery.</span></p><p><span style="font-family: Calibri;"><strong>Results: </strong>Among 2574 patients (2025 men and 549 women) referred for diagnostic coronary angiography, 151 (5.8%) had non-obstructive coronary angiograms. Six-years follow-up was available in 127 patients (63 men and 64 women). Persistence of angina was reported in 20.4%. Four patients (3.1%) had acute myocardial infarction and two (1.6%) had stroke.</span></p><p><span style="font-family: Calibri;"><strong>Conclusion: </strong>During a six-years follow-up, persistence of angina and occurrence of acute major CV events were found in a significant proportion of patients with stable angina and non-obstructive coronary angiograms.</span></p>

scholarly journals Right Coronary Artery Originating from the Left: Do Not Miss the Diagnosis!

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Sedat Türkoğlu ◽  
Serkan Ünlü ◽  
Gülten Aydoğdu Taçoy ◽  
Murat Özdemir
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Common Type ◽  
Coronary Anomaly ◽  
Single Center ◽  
Catheterization Laboratory ◽  
True Prevalence ◽  
Frequent Form ◽  
The Right ◽  
Coronary Angiograms

Objective. Left circumflex (LCx) artery originating from the right coronary arterial (RCA) system has been reported as the most common form of anomalous origination of a coronary artery from the opposite sinus (ACAOS). However, some studies claim that RCA originating from the left coronary sinus (LCS) is the most frequent form. The aim of this study was to determine the most common type of ACAOS in a single center.Materials and Methods. The database of the catheterization laboratory was retrospectively searched. All patients who were performed coronary angiography between 1999 and 2006 were included to registry. All examinations were carefully analyzed to determine the most frequent type of ACAOS.Results. We detected ACAOS in 35 cases (16 RCA originating from the LCS, 13 LCx from the RCS or the RCA, and 6 others) out of 5165 coronary angiograms. The most common form was RCA originating from LCS. Moreover, we revealed that 5 cases with RCA originating from the LCS were previously misdiagnosed and not reported as a coronary anomaly.Conclusions. RCA originating from the LCS was the most common form of ACAOS in our registry. The high change of misdiagnosis or underreporting of this anomaly could have biased the true prevalence.

scholarly journals INCIDENCE AND CHARACTERISTICS OF CORONARY ARTERY ECTASIA IN PATIENTS UNDERGOING CORONARY ANGIOGRAPHY AT ARMY CARDIAC CENTER LAHORE

2021 ◽  
Vol 70 (Suppl-4) ◽  
pp. S876-80
Author(s):  
Faisal Shafiq ◽  
Ahmad Usman ◽  
Mehboob Sultan ◽  
Khurram Shehzad ◽  
Namra Haroon ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Right Coronary Artery ◽  
Laboratory Data ◽  
Prospective Analysis ◽  
Coronary Artery Ectasia ◽  
Catheterization Laboratory ◽  
Common Clinical Presentation ◽  
Coronary Angiograms ◽  
Cardiac Center

Objective: To estimate the incidence and characteristics of coronary artery ectasia in patients undergoing coronary angiography. Study Design: A prospective analysis. Place and Duration of Study: This study was conducted at Army Cardiac Center, Lahore over a period of two years from Jan 2018 to Dec 2019. Methodology: Its prospective analysis of all coronary angiograms performed in our catheterization laboratory during study period. Markis classification was the basis to define and classify coronary artery ectasia. Demographical, clinical, and laboratory data were collected for each patient in this study. Results: A total of 172 (3.9%) out of 4,372 coronary angiograms showed coronary artery ectasia. Among coronary artery ectasia group, mean age 58 ± 10 years, 90% were male, 47% were current smokers, 32% were hypertensive, 15% had diabetes Mellitus and 37% had dyslipidemia. The most common clinical presentation was Non STsegment elevation myocardial infarction (31%), followed by Stable ischemic heart disease in 28%. Right coronary artery was the most frequent coronary artery involved (57%) while Markis Class 3 pattern was seen as most common type of coronary artery ectasia. Conclusion: The frequency of coronary artery ectasia among our patients undergoing coronary angiography was about 4%. Right coronary artery remained the most common affected artery.

scholarly journals Coronary Physiology in the Cardiac Catheterization Laboratory

2019 ◽  
Vol 8 (2) ◽  
pp. 255 ◽  
Author(s):  
Samit Shah ◽  
Steven Pfau
Keyword(s):  
Coronary Artery Disease ◽  
Clinical Trials ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Flow ◽  
Coronary Physiology ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Flow Reserve ◽  
Artery Disease

Coronary angiography has been the principle modality for assessing the severity of atherosclerotic coronary artery disease for several decades. However, there is a complex relationship between angiographic coronary stenosis and the presence or absence of myocardial ischemia. Recent technological advances now allow for the assessment of coronary physiology in the catheterization laboratory at the time of diagnostic coronary angiography. Early studies focused on coronary flow reserve (CFR) but more recent work has demonstrated the physiologic accuracy and prognostic value of the fractional flow reserve (FFR) and instantaneous wave free ratio (iFR) for the assessment of coronary artery disease. These measurements have been validated in large multi-center clinical trials and have become indispensable tools for guiding revascularization in the cardiac catheterization laboratory. The physiological assessment of chest pain in the absence of epicardial coronary artery disease involves coronary thermodilution to obtain the index of microcirculatory resistance (IMR) or Doppler velocity measurement to determine the coronary flow velocity reserve (CFVR). Physiology-based coronary artery assessment brings “personalized medicine” to the catheterization laboratory and allows cardiologists and referring providers to make decisions based on objective findings and evidence-based treatment algorithms. The purpose of this review is to describe the theory, technical aspects, and relevant clinical trials related to coronary physiology assessment for an intended audience of general medical practitioners.

scholarly journals Ten-year cardiovascular risk in diabetes patients without obstructive coronary artery disease: a retrospective Western Denmark cohort study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Kevin Kris Warnakula Olesen ◽  
Morten Madsen ◽  
Christine Gyldenkerne ◽  
Pernille Gro Thrane ◽  
Troels Thim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Ischemic Stroke ◽  
Coronary Artery ◽  
General Population ◽  
Coronary Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Increased Risk ◽  
Artery Disease ◽  
Diabetes Patients

Abstract Background Diabetes patients without obstructive coronary artery disease as assessed by coronary angiography have a low risk of myocardial infarction, but their myocardial infarction risk may still be higher than the general population. We examined the 10-year risks of myocardial infarction, ischemic stroke, and death in diabetes patients without obstructive coronary artery disease according to coronary angiography, compared to risks in a matched general population cohort. Methods We included all diabetes patients without obstructive coronary artery disease examined by coronary angiography from 2003 to 2016 in Western Denmark. Patients were matched by age and sex with a cohort from the Western Denmark general population without a previous myocardial infarction or coronary revascularization. Outcomes were myocardial infarction, ischemic stroke, and death. Ten-year cumulative incidences were computed. Adjusted hazard ratios (HR) then were computed using stratified Cox regression with the general population as reference. Results We identified 5734 diabetes patients without obstructive coronary artery disease and 28,670 matched individuals from the general population. Median follow-up was 7 years. Diabetes patients without obstructive coronary artery disease had an almost similar 10-year risk of myocardial infarction (3.2% vs 2.9%, adjusted HR 0.93, 95% CI 0.72–1.20) compared to the general population, but had an increased risk of ischemic stroke (5.2% vs 2.2%, adjusted HR 1.87, 95% CI 1.47-2.38) and death (29.6% vs 17.8%, adjusted HR 1.24, 95% CI 1.13–1.36). Conclusions Patients with diabetes and no obstructive coronary artery disease have a 10-year risk of myocardial infarction that is similar to that found in the general population. However, they still remain at increased risk of ischemic stroke and death.

scholarly journals Coronary Artery Spasm is Associated With an Increased Risk of Incident Diabetes: A Nationwide Population-Based Cohort Study

2020 ◽  
Author(s):  
Ming-Jui Hung ◽  
Nen-Chung Chang ◽  
Patrick Hu ◽  
Tien-Hsing Chen ◽  
Chun-Tai Mao ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Median Time ◽  
Obstructive Coronary Artery Disease ◽  
Coronary Artery Spasm ◽  
Incident Diabetes ◽  
Control Group ◽  
Chronic Obstructive ◽  
Research Database ◽  
Increased Risk

Abstract BackgroundNon-diabetic coronary artery spasm (CAS) without obstructive coronary artery disease increases insulin resistance. We investigated the risk of incident type 2 diabetes (diabetes) associated with CAS.MethodsPatient records were retrospectively collected from the Taiwan National Health Insurance Research Database during the period 2000-2012. The matched cohorts consisted of 12,413 patients with CAS and 94,721 patients in the control group. ResultsDuring the entire follow-up, the incidence of newly-diagnosed diabetes was 22.2 events per 1000 person-years in the CAS group and 13.9 events per 1000 person-years in the control group. The increased risk of CAS-related incident diabetes was observed regardless of sex and length of follow-up. The median time to incident diabetes was 2.9 and 3.5 years in the CAS and the control group (P <0.001), respectively, regardless of sex. Although age did not affect the risk of CAS-related incident diabetes, the risk was less apparent in the subgroups of male, dyslipidemia, chronic obstructive pulmonary disease, stroke, gout and medicated hypertension. However, CAS patients aged <50 years compared with patients ≥50 years had a greater risk of incident diabetes in females but not in males. Older CAS patients developed diabetes in a shorter length of time than younger patients.ConclusionCAS is a risk factor for incident diabetes regardless of sex. However, females aged <50 years have a more apparent risk for CAS-related diabetes than old females, which is not observed in males. The median time of 2.9 years to incident diabetes warrants close follow-up.

Twenty-year survival of patients with atherosclerotic non-obstructive coronary plaques

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
O Hlinomaz ◽  
M Sabbah ◽  
J Jarkovsky ◽  
J Machal
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Invasive Coronary Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Survival Rates ◽  
Chronic Stable Angina ◽  
Administrative Databases ◽  
Predictors Of Mortality ◽  
Luminal Narrowing

Abstract Background Atherosclerotic non-obstructive coronary artery disease (NObCAD) is frequently observed in patients referred for coronary angiography. No available data exist for the long-term prognosis of NObCAD patients beyond 10 years. Purpose We sought to compare the 15- and 20-year survival among patients presenting with chronic stable angina who had smooth coronary vessels, NobCAD, and obstructive (ObCAD), on invasive coronary angiography. Methods Coronary angiography of 671 consecutive patients presented with suspected CAD were retrospectively evaluated from single center registry between January and December 1998 and linked to administrative databases for outcomes evaluation. No CAD, NobCAD, and ObCAD were defined as 0%, 1% to 49%, and ≥50% luminal narrowing in epicardial coronary artery, respectively. The 15- and the 20-year survival rates were compared by Kaplan-Meier curve and multivariate Cox proportional hazards regression was used to identify significant independent predictors of mortality. Results Of 613 individuals (78.7% men with median age of 55.6 (51.0–65.2) years), 74 (12.1%) had normal coronary arteries, 42 (6.9%) had NobCAD, and 497 (81%) had ObCAD. The 15- and the 20-year survival rates were 89%, 66.7%, 62.4% and 79.7%, 54.7%, 42,5% in patients with normal, NobCAD, and ObCAD, respectively, (P=0.050 for no versus NobCAD; P=0.001 for no versus ObCAD at 20-year), These angiographic severity categories showed a strong gradient (P&lt;0.001) (Figure 1). At 15-year follow-up, both ObCAD (adjusted HR=2.42, 95% CI (1.21–4.85), p=0.013) and NobCAD patients (HR=2.65, 95% CI (1.15–6.11), p=0.023) showed higher mortality compared to no CAD group. Independent predictors of mortality were, obstructive CAD (HR=2.34, 95% CI (1.407–3.916), P=0.001 for no versus NobCAD; HR=1.93, 95% CI (1.0–3.72), P=0.050, for no versus obstructive CAD), and age at addmission (HR=1.06, 95% CI (1.04–1.07), P&lt;0.001). Conclusion The result of this analysis highlighted the less benign course of NobCAD that carries a mortality risk similar to patients with ObCAD at 15-and at 20-year follow-up. These findings support the need for aggressive anti-atherosclerotic drug therapy in such individuals and underscore the necessary efforts to improve the risk stratification and management of patients with non-obstructive CAD. Funding Acknowledgement Type of funding source: None

Higher BNP/NT-proBNP levels stratify prognosis in patients with coronary artery disease but without heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Hendricks ◽  
I Dykun ◽  
B Balcer ◽  
F Al-Rashid ◽  
P Luedike ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Natriuretic Peptides ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
Artery Disease

Abstract Background Natriuretic peptides (BNP/NT-proBNP) are routinely used for the diagnosis of heart failure and predicts outcome in patients with both heart failure with preserved and reduced ejection fraction. In addition, natriuretic peptides are associated with incident cardiovascular disease manifestation in primary prevention cohorts. Whether the assessment of BNP/NT-proBNP is of value in patients with coronary artery disease but without heart failure has not been investigated in detail. We here evaluate the association of BNP/NT-pro BNP with mortality patients with coronary artery disease but without known chronic heart failure. Methods The present analysis is based on the ECAD registry of patients undergoing conventional coronary angiography at the Department of Cardiology and Vascular Medicine between 2004 and 2019. For this analysis, we excluded all patients with a diagnosis of heart failure or with elevated BNP/NT-proBNP values at baseline (&gt;100pg/nl for BNP, &gt;400pg/nl for NTproBNP). Moreover, patients with missing follow-up information or without BNP/NT-proBNP levels at admission were excluded. As either BNP or NT-proBNP was available for singular patients, we standardized BNP and NT pro BNP levels based on percentile rank in levels from 0 to 99. Cox regression analysis was used to determine the association of BNP/NT-proBNP with morality in unadjusted and risk factor adjusted models with effect sizes depicted per one standard deviation change in BNP/NT-proBNP rank. Results Overall, 3738 patients (mean age: 62.8±12.6 years, 71% male) were included in our analysis. During a mean follow-up of 2.6±3.5 years, 172 deaths of any cause occurred. Patients without fatal events had significantly lower BNP/NT-prBNP values compared to patients who died (48.4±28.8 vs. 58.4±27.5, p&lt;0.0001). In unadjusted cox regression analysis, BNP/NT-proBNP increase by one standard deviation was associated with a 47% increased risk of morality (HR (95% CI): 1.47 (1.25–1.72), p&lt;0.0001). Upon adjustment for cardiovascular risk factors, the significant link between BNP/NT-proBNP levels and morality remained (HR (95% CI): 1.38 (1.14–1.66). Effect sizes were similar for patients receiving coronary revascularization therapy as part of the coronary angiography (1.32 [1.03–1.70], p=0.03) as well as for patients with purely diagnostic procedures (1.58 [1.28–1.94], p&lt;0.0001). Conclusion In patients without heart failure undergoing coronary angiography, BNP/NT-proBNP levels stratify mortality risk independently of traditional cardiovascular risk factors. Our results support the routine assessment of natriuretic peptides also in patients without heart failure to identify patients at increased risk. Funding Acknowledgement Type of funding source: None

scholarly journals Stable Angina Pectoris: One-Year Outcomes of Patients with Obstructive Coronary Artery Disease: Multicenter Sutdy in Dakar (Senegal)

2022 ◽  
Vol 5 (1) ◽  
pp. 01-07
Author(s):  
Paul Coffi HESSOU ◽  
Joseph Salvador MINGOU ◽  
Maboury DIAO ◽  
Fatou AW LEYE ◽  
Mouhamadou Bamba NDIAYE ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Angina Pectoris ◽  
Stable Angina ◽  
Obstructive Coronary Artery Disease ◽  
Artery Disease ◽  
Stable Chest Pain ◽  
One Year

Background: CAD management is important in prevention of disease progression. But we have very little study or research on the evolution of stable angina in amulatory patients without coronary antecedents and with obstructive coronary disease. Purpose: The objective of our study was to analyze the clinical and angiographic profil of patients with stable chest pain and to assess their angina status one year outcomes. Patients and methods: All patients who presented with symptomatic angina pectoris and/or signs of ischemia and first diagnosis of obstructive CAD in the Cardiology Departments of Idrissa Pouye General Hospital and Aristide Le Dantec National University Hospital Center of Dakar, from March 01, 2019 to December 31, 2020 were selected. The clinical characteristics, initial angiographic findings, therapeutic strategy and outcome within the first year were analyzed. Results: During the study period, 84 outpatients presenting with symptomatic stable chest pain and first obstructive coronary artery disease were selected. The mean age was 63.01± 9.37 years. Male preponderance was observed with 63(75%) patients; Clinical symptoms were dominated by typical pain with 46.4% (n=39) ; the risk factors were dominated by hypertension 61.9% (n=52); diabetes 41.7% (n=35) and dyslipidemia 33.3% (n=28). During follow-up, 10 patients (11.90%) remained untraceable while 9 patients (10.71%) were not available for check-up; 3 patients (3.57%) died during follow-up. Only 62 patients (73.80) could be evaluated; among those who were alive and controlled, 26 patients (41.93%) with angina at baseline still had angina symptoms, 2 patients (3.22%) had undergone myocardial infarction; one (1.61%) had undergone urgent revascularization; one (1.61%) patient developed heart failure. Finally 32 patients (51.61%) were event-free and angina-free Conclusion: The management of outpatients with stable chest pain and first obstructive CAD appears favourable, with good adherence to guideline-based therapies one year outcomes. Stable chest pain is not associated with an increased risk for adverse cardiovascular outcomes but there remains room for improvement in terms of risk factor control.

scholarly journals Electrocardiographic (ECG) predictors of major adverse cardiac events in women with ischemia and no obstructive coronary artery disease (INOCA)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y.K Taha ◽  
K Xu ◽  
A.A Mahmoud ◽  
S.M Smith ◽  
E.M Handberg ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Funding Source ◽  
Cardiac Events ◽  
T Wave ◽  
Adverse Cardiac Events ◽  
Artery Disease

Abstract Introduction The Women's Ischemia Syndrome Evaluation (WISE) studies observed that majority of women undergoing coronary angiography for symptoms/signs of ischemia have no obstructive coronary artery disease (INOCA) but have an increased risk of major adverse cardiac events (MACE) exceeding 2.5% yearly by 5 years. Identifying modifiable and non-modifiable factors that help predict or contribute to adverse outcomes in this population is important. Purpose Identifying electrocardiographic predictors of MACE in women with INOCA. Methods In a cohort of women referred for coronary angiography between 1996–2001 for symptoms and/or signs of ischemia, 944 underwent a resting 12-lead ECG at baseline read at core lab. No obstructive CAD was found in 567/944 (60%), (mean age 55.6±11 years). Complete follow up information for MACE as (first occurrence of all-cause death, nonfatal myocardial infarction (MI), nonfatal stroke, or hospitalization for heart failure) or angina was available in 425 women. Results At follow up (median 5.9 years) MACE had occurred in 17.6% with angina hospitalization in 22.8% of these women. Women who experienced MACE were older (mean age 59±11 vs 55±10 years, P=0.02) and had longer corrected QT interval (mean QTc 437±29.7 vs 425±26.7 ms, P=0.001) vs. women without MACE. Diabetes, hypertension and history of smoking did not differ between MACE groups. Predictors of MACE by univariate analysis were: age at presentation (P=0.013), baseline heart rate (P=0.03), and QTc (P=0.0005). Baseline ST-T wave changes, QTc and waist circumference predicted angina hospitalization (P=0.003, 0.003 and 0.013 respectively). After adjusting for other risk factors in the multivariate analysis (see Figure) QTc, peripheral arterial disease (PAD) and current smoking were found to be independent predictors for MACE. ST-T wave changes and QTc independently predicted angina hospitalizations. Conclusion Among ECG findings in women with INOCA, QTc was a significant predictor of MACE and this was driven by hospitalization with angina. Ongoing ischemia likely contributes to these baseline ECG signals which could prove useful to better select subgroups for more intense anti-ischemic management. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Heart, Lung, and Blood Institute (NHLBI)

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