Non obstructive versus obstructive coronary artery disease documented by coronary angiography: prevalence, diagnostic features in a single center experience

Authors

  • Hasanain Ali Malallah Alftailah Department of Internal Medicine, Al-Hussein Medical City, Kerbala Health Directorate, Kerbala, Iraq
  • Ali K. N. Rufaish Department of Internal Medicine, Al-Hussein Medical City, Kerbala Health Directorate, Kerbala, Iraq

DOI:

https://doi.org/10.18203/2320-6012.ijrms20242203

Keywords:

Coronary artery disease, Coronary angiography, Non-obstructive, Obstructive

Abstract

Background: Coronary angiography often detects NOCAD. Stable angina or MI patients may have NOCAD, defined as less than 50% luminal diameter decrease by visual assessment on coronary angiography. The study was to determine the frequency of non-obstructive coronary artery disease in Al Hussain cardiac centre patients who underwent CAG and the differences in clinical presentation and associated morbidity between the two groups.

Methods: Cross-sectional research was done at Karbala's al-Hussaini cardiac centre. CAG data from 167 IHD-like patients between January and May 2021. NOCAD 42 individuals (stenosis <50%) were compared to 125 obstructive CAD patients (≥50% stenosis).

Results: Between January and May 2021, 167 individuals received CAG for diagnostic, therapeutic, elective, or emergency purposes. The study included 113 (67.7%) men and 54 (32.3%) women. Patients had an average age of 56.52±11.09 years, with a median of 58 years. Overall, 25.1% (n=42) of research participants had NOCAD. The frequency of INOCA was 29.4% and MINOCA 19.1%. Patients with NOCAD were younger than those with obstructive CAD (p<0.05). no significant gender, co morbidity, or clinical differences across groups.

Conclusions: We believe this is the first report of prevalence, risk factors, and clinical aspects in karbalai patients' cardiac care centre in Iraq. NOCAD patients are younger and their medical history, clinical features, ECG, and serum troponin are difficult to distinguish from OCAD.

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References

Khan MA, Hashim MJ, Mustafa H, Baniyas MY, Al Suwaidi SKBM, AlKatheeri R, et al. Global epidemiology of ischemic heart disease: results from the global burden of disease study. Cureus. 2020;12(7):9349.

Ahn JM. Coronary Microvascular Dysfunction: Is it distinct clinical entity or common physiologic pathway? Korean Circ J. 2020;50(10):904-6.

Badimon L, Padró T, Vilahur G. Atherosclerosis, platelets and thrombosis in acute ischaemic heart disease. Eur Heart J Acute Cardiovasc Care. 2012;1(1):60-74.

Mehta PK, Quesada O, Al-Badri A, Fleg JL, Volgman AS, Pepine CJ, Merz CNB, Shaw LJ. Ischemia and no obstructive coronary arteries in patients with stable ischemic heart disease. Int J Cardiol. 2022;348:1-8.

Carbone S, Narula J, Lavie CJ, Niccoli G, Crea F. Coronary Microvascular Dysfunction Across the Spectrum of Cardiovascular Diseases: JACC State-of-the-Art Review. J Am Coll Cardiol. 2021;78(13):1352-71.

Marano P, Wei J, Merz CNB. Coronary Microvascular Dysfunction: What Clinicians and Investigators Should Know. Curr Atheroscler Rep. 2023;25(8):435-46.

Mangiacapra F, Viscusi MM, Verolino G, Paolucci L, Nusca A, Melfi R, Ussia GP, Grigioni F. Invasive Assessment of Coronary Microvascular Function. J Clin Med. 2021;11(1):228.

Mileva N, Nagumo S, Mizukami T, Sonck J, Berry C, Gallinoro E, Monizzi G, Candreva A, Munhoz D, Vassilev D, Penicka M, Barbato E, De Bruyne B, Collet C. Prevalence of Coronary Microvascular Disease and Coronary Vasospasm in Patients With Nonobstructive Coronary Artery Disease: Systematic Review and Meta-Analysis. J Am Heart Assoc. 2022;11(7):23207.

Safdar B, Spatz ES, Dreyer RP, Beltrame JF, Lichtman JH, Spertus JA et al. Presentation, clinical profile, and prognosis of young patients with myocardial infarction with nonobstructive coronary arteries (MINOCA): results from the VIRGO study. J Am Heart Assoc. 2018:7.

Bugiardini R, Manfrini O, De Ferrari GM. Unanswered questions for management of acute coronary syndrome: risk stratification of patients with minimal disease or normal findings on coronary angiography. Arch Intern Med. 2006;166:1391-5.

Mohammed AA, Zhang H, Abdu FA, Liu L, Singh S, Lv X, Shi T et al. Effect of nonobstructive coronary stenosis on coronary microvascular dysfunction and long-term outcomes in patients with INOCA. Clin Cardiol. 2023;46(2):204-13.

Maddox TM, Stanislawski MA, Grunwald GK, Bradley SM, Ho PM, Tsai TT, et al. Nonobstructive coronary artery disease and risk of myocardial infarction. JAMA. 2014;312:1754-63.

Schulman-Marcus J, Hartaigh BÓ, Gransar H, Lin F, Valenti V, Cho I, et al. Sex-specific associations between coronary artery plaque extent and risk of major adverse cardiovascular events: the CONFIRM long-term registry. J Am Coll Cardiol Cardiovasc Imaging. 2016;9:364-72.

Shamsi F. Clinical overview of myocardial infarction without obstructive coronary artery disease (MINOCA). J Saudi Heart Assoc. 2021;33:9.

Farrehi PM, Bernstein SJ, Rasak M, Dabbous SA, Stomel RJ, Eagle KA, et al. Frequency of negative coronary arteriographic findings in patients with chest pain is related to community practice patterns. Am J Manag Care. 2002;8:643-8.

Bradley SM, Maddox TM, Stanislawski MA, O'Donnell CI, Grunwald GK, Tsai TT, et al. Normal coronary rates for elective angiography in the Veterans Affairs healthcare system: insights from the VA CART program (Veterans Affairs Clinical Assessment Reporting and Tracking). J Am Coll Cardiol. 2014;63:417-26.

Hasdai D, Holmes DR Jr, Higano ST, Burnett JC Jr, Lerman A. Prevalence of coronary blood flow reserve abnormalities among patients with nonobstructive coronary artery disease and chest pain. Mayo Clin Proc. 1998;73:1133-40.

Shaw LJ, Shaw RE, Merz CN, Brindis RG, Klein LW, Nallamothu B, et al. Impact of ethnicity and gender differences on angiographic coronary artery disease prevalence and in hospital mortality in the American College of Cardiology-National Cardiovascular Data Registry. Circulation. 2008;117:1787-801.

Johnston N, Schenck-Gustafsson K, Lagerqvist B. Are we using cardiovascular medications and coronary angiography appropriately in men and women with chest pain? Eur Heart J. 2011;32:1331-6.

Sharaf B, Wood T, Shaw L, Johnson BD, Kelsey S, Anderson RD, et al. Adverse outcomes among women presenting with signs and symptoms of ischemia and no obstructive coronary artery disease: findings from the National Heart, Lung, and Blood Institute-sponsored Women's ischemia syndrome evaluation (WISE) angiographic core laboratory. Am Heart J. 2013;166:134-41.

Kunadian V, Chieffo A, Camici PG, Berry C, Escaned J, Maas AHEM et al. An eapci expert consensus document on ischaemia with non-obstructive coronary arteries in collaboration with european society of cardiology working group on coronary pathophysiology and microcirculation endorsed by coronary vasomotor disorders International study group. Euro Intervention. 2021;16(13):1049-69.

McEntegart M, Eteiba H, Watkin S, Shaukat A, Lindsay M, Robertson K, et al. Systemic microvascular dysfunction in microvascular and vasospastic angina. Eur Heart J. 2018;39:4086-97.

Padro T, Manfrini O, Bugiardini R, Canty J, Cenko E, De Luca G, et al. ESC Working Group on Coronary Pathophysiology and Microcirculation position paper on ‘coronary microvascular dysfunction in cardiovascular disease’. Cardiovasc Res. 2020;116:741-55.

Rozanski A, Qureshi E, Bauman M, Reed G, Pillar G, Diamond GA. Peripheral arterial responses to treadmill exercise among healthy subjects and atherosclerotic patients. Circulation. 2001;103:2084-9.

Yun JS, Park YM, Cha SA, Ahn YB, Ko SH. Progression of cardiovascular autonomic neuropathy and cardiovascular disease in type 2 diabetes. Cardiovasc Diabetol. 2018;17:109.

Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined-a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol. 2000;36(3):959-69.

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Published

2024-07-31

How to Cite

Alftailah, H. A. M., & Rufaish, A. K. N. (2024). Non obstructive versus obstructive coronary artery disease documented by coronary angiography: prevalence, diagnostic features in a single center experience. International Journal of Research in Medical Sciences, 12(8), 2740–2746. https://doi.org/10.18203/2320-6012.ijrms20242203

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Original Research Articles