Non-occlusive coronary artery lesions in the diagnosis of coronary artery disease: prevalence and verification tools

Abstract

Aim. To asess the prevalence andfactors of nonobstructive coronary artery disease identified with routine coronary angiography (CAG). Material and Methods. 457 medical records of patients undergoing routine coronary angiography at the Kemerovo Cardiology Center during the period from April 1 to May 31, 2014 were retrospectively reviewed. All the patients were assigned to two groups: Group 1 - patients with suspected coronary artery disease (CAD) (n=248), Group 2 - patients with a history of myocardial infarction (MI) (n-209). Results. According to the CAG findings, the absence of occlusive and stenotic lesions as well as nonsignificant coronary artery disease (stenosis <60%) were commonly found inpatients with suspected CAD (42.7% and 17.3%), compared to Group 2 with a history of MI (12.9% and 8.1%), respectively (p<0.001 and p-0.004). Thus, significant coronary artery lesions (stenosis >70%) were more often found in patients with a history of MI (76.6% vs. 36.3%, respectively, p<0.001). Typical signs and symptoms of angina pectoris were commonly found in both groups - 59.3% and 54.6%, respectively (p-0.309). Atypical signs and symptoms of angina and cardialgia were more often found in patients with suspected CAD (p-0.002 vs.p<0.001). The pretest probability of the presence of CAD was 68% vs. 77% (p-0.007). Bicycle ergometry was performed in 11.1% vs. 7.9% (p-0.038), and 24-hour ECG monitoring - in 28.1% vs. 19.9% (p-0.02). Increased probability of normal coronary arteries detecting was associated with the presence of atypical angina and cardialgia, increased left ventricular ejectionfraction,female gender, whereas decreased probability - with the presence of diabetes, symptoms of congestive heart failure, advanced age and statin therapy. Conclusion. 42.7% of patients with suspected CAD and 12.9% of patients with a history of MI demonstrated the absence of coronary artery lesions according to the CAG results. Clinical symptoms and manifestations should be carefully evaluated inpatients in order to reduce the detection rate of normal coronary arteries. Other options (an accurate method of calculating the pretest probability, adequate protocols of functional tests, diagnostic use of multislice computed tomography) require further investigation.