Cardiac catheterization with normal coronary arteries: prevalence rate and analysis of predictor variables

Abstract

Objective: To assess the percentage of patients with normal coronary angiography in a hospital and to determine the predictor variables of this finding. Methods: All elective coronary angiographies performed from April to October 2018 were analyzed, excluding patients with valve diseases and who had a previous catheterization. A total of 503 patients were recruited, divided into 2 groups: Group A for normal coronary arteries, and group B for coronary artery disease. Coronary vessels with diameter ≥2.0mm and with no stenosis ≥40% determined by quantitative coronary angiography were considered normal. After the univariate analysis of the differences between groups, a multivariate analysis was performed by logistic regression, to determine the independent predictors of a normal exam. Results: The clinical characteristics were as follows: mean age of 62 years; 55% male; hypertension present in 86%; diabetes mellitus in 35%; smoking habit reported by 20.5%; dyslipidemia present in 20.5%; and family history of coronary artery disease in 59%. The prevalence of normal coronary angiography was 45%. In the univariate analysis, there were differences between the two groups in regard to sex, age, symptoms, diabetes mellitus and smoking habit. In the multivariate analysis, female sex (OR=3.22; 95%CI 2.20-4.80; p<0.0001), younger age (OR=0.96; 95%CI 0.94-0.98; p<0.0001), absence of diabetes mellitus (OR=0.46; 95%CI 0.30-0.70; p<0.0001), and no smoking habit (OR=0.33; 95%CI 0.19-0.55; p<0.0001) were predictors of normal coronary angiography. Conclusion: The prevalence of normal coronary arteries in this study was high. Female sex, younger age, absence of diabetes mellitus, and no smoking habit were independent predictors of this finding. RESUMO -Objetivo:Averiguar o percentual de pacientes com coronariografia normal em um hospital e determinar as variáveis preditoras desse achado. Métodos: Foram analisadas todas as co ro nariografias eletivas realizadas de abril a outubro de 2018, excluindo pacientes com doenças valvares e que já tinham cateterismo prévio. Foram recrutados 503 pacientes, divididos em 2 grupos: A para coronárias normais e B para doença arterial coronariana. Foram consideradas coronárias normais vasos ≥2,0mm e sem lesões ≥40% pela angiografia coronariana quantitativa. Após análise univariada das diferenças entre os grupos, foi realizada análise multivariada por regressão logística, para determinar os preditores independentes de um exame normal. Resultados: As características clínicas foram as seguintes: média de idade de 62 anos; 55% do sexo masculino; hipertensão arterial sistêmica presente em 86%; diabetes melito em 35%; tabagismo relatado por 20,5%; dislipidemia encontrada em 20,5%; e achado de história familiar de doença arterial coronariana em 59%. A prevalência de coronariografia normal foi de 45%. Na análise univariada, houve diferença entre os dois grupos em relação a sexo, idade, sintomas, diabetes e tabagismo. Na análise multivariada, sexo feminino (RC=3,22; IC95% 2,20-4,80; p<0,0001), idade mais jovem ...

Estudo Comparativo da Doença Coronariana Microvascular Causada por Doença de Chagas e por Outras Etiologias

“…Also, our sample of 247 patients with angiographically normal coronary arteries was selected among 691 consecutive patients in whom other abnormalities had been excluded, and correspond to nearly 36% of such individuals who are referred for elective coronary angiography. This finding is inferior to 45% recently reported by another Brazilian hospital, 25 but is quite similar to the reported 39% of patients with coronary stenoses < 20% as the general yield by elective coronary angiography during the years 2004-2008 from an American College of Cardiology national registry. 26 …”

“…Além disso, nossa amostra de 247 pacientes com artérias coronárias angiograficamente normais foi selecionada entre 691 pacientes consecutivos, nos quais outras anormalidades foram excluídas, e corresponde a quase 36% dos indivíduos encaminhados para angiografia coronariana eletiva no período. Esse resultado é inferior aos 45% relatado recentemente por outro hospital brasileiro, 25 mas é muito semelhante aos 39% de pacientes com estenoses coronárias < 20% submetidos à angiografia coronária eletiva entre os anos de 2004 e 2008, segundo o registro nacional do American College of Cardiology. 26 Com exceção da média de idade discretamente mais elevada no grupo DMC-OE, vale ressaltar que os dois grupos em nosso estudo apresentavam características antropométricas e clínicas essencialmente similares, incluindo uma maior prevalência do gênero feminino, pacientes ligeiramente obesos que, além da angina atípica, também se queixaram de dispneia e palpitações.…”

“…Além disso, nossa amostra de 247 pacientes com artérias coronárias angiograficamente normais foi selecionada entre 691 pacientes consecutivos, nos quais outras anormalidades foram excluídas, e corresponde a quase 36% dos indivíduos encaminhados para angiografia coronariana eletiva no período. Esse resultado é inferior aos 45% relatado recentemente por outro hospital brasileiro, 25 mas é muito semelhante aos 39% de pacientes com estenoses coronárias < 20% submetidos à angiografia coronária eletiva entre os anos de 2004 e 2008, segundo o registro nacional do American College of Cardiology . 26 …”

Optimizing coronary angiography in Brazil: a legacy from the COVID-19 era

“…However, previous studies, such as one by Shah et al, suggested that QCA tends to underestimate the diagnosis of obstructive CAD when compared to visual estimation. 11 This may have been one of the factors that contributed to the higher percentage of normal exams found by Sant'Anna et al 6 The prevalence of CAD found in previous studies, such as Ferreira et al and Levitti et al, were determined by visual estimation of the lesions, hindering direct comparison of findings. 7,8 In addition, previous studies have not shown a predictable correlation of severity of the obstruction estimated by QCA with the functional impact of the lesion measured by fractional flow reserve (FFR).…”

“…5 Considering this basic scenario, the article published by Sant'Anna et al has great relevance, for it shows national data on the prevalence of elective coronary angiography with absence of obstructive lesions. 6 In the study, 503 consecutive patients with no anatomically known CAD underwent elective diagnostic coronary angiography in a private organization in Cabo Frio, in the state of Rio de Janeiro. Almost 90% of patients were from SUS units, stratified into two groups, according to presence or absence of significant obstructive CAD on coronary angiography.…”