Appropriate Referrals of Angiography Despite High Prevalence of Normal Coronary Arteries or Nonobstructive CAD

Ouellette, Michelle L.; Löffler, A; Workman, Virginia; Bourque, Jamieson M.

doi:10.1016/j.jacc.2017.03.565

Cited by 6 publications

(9 citation statements)

References 4 publications

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“…Appropriateness of ICA in patients without NSTEMI from this cohort was reported previously in a research letter. 16 For this current expanded patient population, which included 258 NSTEMI patients, ICA was classified as appropriate in 918 patients (99.2%). The 7 patients with inappropriate indications for ICA all had NNCAs.…”

Section: Appropriateness Of Icamentioning

confidence: 99%

Clinical Characteristics, Sex Differences, and Outcomes in Patients With Normal or Near‐Normal Coronary Arteries, Non‐Obstructive or Obstructive Coronary Artery Disease

Ouellette

Löffler

Beller

et al. 2018

JAHA

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BackgroundNormal or near‐normal coronary arteries (NNCAs) or nonobstructive coronary artery disease (CAD) are found on invasive coronary angiography in ≈55% of patients. Some attribute this to frequent referral of low‐risk patients. We sought to identify the referral indications, pretest risk, key clinical characteristics, sex, and outcomes in patients with NNCAs and nonobstructive CAD versus obstructive CAD on nonemergent invasive coronary angiography.Methods and ResultsOver 24 months, 925 consecutive patients were classified as having NNCAs (≤20% stenosis), nonobstructive CAD (21–49% stenosis), or obstructive CAD (≥50% stenosis). Outcomes included cardiac death, nonfatal myocardial infarction, and late revasclarization. NNCAs were found in 285 patients (31.0%), nonobstructive CAD in 125 (13.5%), and obstructive CAD in 513 (55.5%). NNCAs or nonobstructive CAD was found in 40.5% with stress ischemia, 27.9% after a non‐ST‐elevation myocardial infarction, and in 55.5% with stable or unstable angina. More women than men (53.5% versus 37.2%; P<0.001) had NNCAs or nonobstructive CAD across all referral indications. Pretest risk was high and ICA appropriate in 75.5% and 99.2% of patients, respectively. Annual rates of cardiac death or nonfatal myocardial infarction were 1.0%, 1.1%, and 6.7%, respectively, for patients with NNCAs, nonobstructive CAD, and obstructive CAD (P<0.001). No sex differences in outcomes were observed with either NNCAs, nonobstructive CAD, or obstructive CAD (P=0.84).ConclusionsMany (44.5%) patients undergoing nonemergent invasive coronary angiography have NNCAs or nonobstructive CAD despite high pretest risk, including ischemia and troponin elevation. Although women had more NNCAs or nonobstructive CAD, there were no differences in event rates by sex. Patients with NNCAs and nonobstructive CAD had very low event rates.

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Section: Appropriateness Of Icamentioning

confidence: 99%

Clinical Characteristics, Sex Differences, and Outcomes in Patients With Normal or Near‐Normal Coronary Arteries, Non‐Obstructive or Obstructive Coronary Artery Disease

Ouellette

Löffler

Beller

et al. 2018

JAHA

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“… 13 Only 55.5% of these patients had obstructive coronary artery disease, with NNCA found in 31% and nonobstructive CAD found in 13.5%. 13 , 24 More women than men had NNCA or nonobstructive CAD. Pretest risk was high in 75% of the cohort.…”

Section: Discussionmentioning

confidence: 99%

“…We previously reported the short‐term cardiac event rates (CD, NFMI infarction and late revascularization) in 925 consecutive patients who underwent non‐emergent ICA for either an abnormal stress test, stable or unstable angina, a NSTEMI or HF 13 . Only 55.5% of these patients had obstructive coronary artery disease, with NNCA found in 31% and nonobstructive CAD found in 13.5% 13,24 . More women than men had NNCA or nonobstructive CAD.…”

Section: Discussionmentioning

confidence: 99%

“…For this cohort, ICA was classified as appropriate in 918 patients (99.2%). 24 The seven patients with inappropriate indications for ICA all had NNCAs.…”

Section: Methodsmentioning

confidence: 98%

“…Appropriateness of ICA in patients without NSTEMI from this cohort was reported previously in a research letter. For this cohort, ICA was classified as appropriate in 918 patients (99.2%) 24 . The seven patients with inappropriate indications for ICA all had NNCAs.…”

Section: Methodsmentioning

confidence: 99%

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

Hanson

Prasad

et al. 2021

Clinical Cardiology

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Background Normal or near normal coronary arteries (NNCA) or nonobstructive coronary artery disease (CAD) are commonly found on invasive coronary angiography (ICA). Hypothesis We aimed to determine long‐term outcomes by severity of CAD in a contemporary cohort of patients undergoing ICA for evaluation for ischemic heart disease. Methods We assessed a consecutive cohort of 925 patients who underwent non‐emergent ICA over 24 months. Cardiac death (CD), nonfatal myocardial infarction (NFMI), late revascularization, and medication use were assessed. Results Follow‐up data was available in 850 patients. Of patients without heart failure, at a median of 6.0 years, there was a significant decrease in survival free from CD or NFMI, and from all cardiac events, for those with obstructive CAD compared with patients with NNCAs or nonobstructive CAD (p < .001 for both). No differences between NNCA and nonobstructive CAD patients in rates of CD or NFMI (2.0% vs. 2.1%/year, p = .58) or all cardiac events (2.4% vs. 2.9%/year, p = .84) were observed. Conclusion Long‐term follow‐up in a contemporary cohort of consecutive patients undergoing non‐emergent ICA for detection of CAD showed no difference in annual rates of CD or NFMI, or total cardiac events, in patients with NNCAs versus those with nonobstructive CAD, whereas patients with obstructive CAD had significantly more events. Event rates were low and similar by gender. Use of aspirin, lipid lowering therapy, and beta‐blockers increased in all subgroups after ICA. We speculate this may explain the low incidence of subsequent cardiac events, and similar event rates in patients with NNCA and nonobstructive CAD, even in patients presenting with non‐ST‐elevation MI.

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Centralized Triage of Suspected Coronary Artery Disease Using Coronary Computed Tomographic Angiography to Optimize the Diagnostic Yield of Invasive Angiography

et al. 2023

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Appropriate Referrals of Angiography Despite High Prevalence of Normal Coronary Arteries or Nonobstructive CAD

Cited by 6 publications

References 4 publications

Clinical Characteristics, Sex Differences, and Outcomes in Patients With Normal or Near‐Normal Coronary Arteries, Non‐Obstructive or Obstructive Coronary Artery Disease

Clinical Characteristics, Sex Differences, and Outcomes in Patients With Normal or Near‐Normal Coronary Arteries, Non‐Obstructive or Obstructive Coronary Artery Disease

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

Centralized Triage of Suspected Coronary Artery Disease Using Coronary Computed Tomographic Angiography to Optimize the Diagnostic Yield of Invasive Angiography

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