Repeat Coronary Angiography in Patients Aged over 50 Years with Previously Normal/Non-Obstructive Coronary Angiogram—Insights from a Retrospective Study
(1) <b>Introduction</b>: A significant proportion of patients undergoing coronary angiography (CAG) have normal (NCA) or non-obstructive coronary artery disease (NOCAD). This study retrospectively tested the incidence of re-catheterization, and long-term outcomes of this population in pa...
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| Format: | Article |
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MDPI AG
2024-02-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/13/3/870 |
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| author | Ariel Roguin Ofer Kobo Simha-Ron Meisel Ziad Darawsha Mahmood Odeh Aharon Frimerman Naama Amsalem Rami Abu Fanne |
| author_facet | Ariel Roguin Ofer Kobo Simha-Ron Meisel Ziad Darawsha Mahmood Odeh Aharon Frimerman Naama Amsalem Rami Abu Fanne |
| author_sort | Ariel Roguin |
| collection | DOAJ |
| description | (1) <b>Introduction</b>: A significant proportion of patients undergoing coronary angiography (CAG) have normal (NCA) or non-obstructive coronary artery disease (NOCAD). This study retrospectively tested the incidence of re-catheterization, and long-term outcomes of this population in patients aged over 50 years. (2) <b>Methods</b>: We identified all patients above 50 years of age with NOCAD who underwent their first CAG at our center between January 2008 and December 2019. Patients were evaluated for their baseline characteristics, risk factors profile, and indication for CAG. Patients undergoing repeat CAG after the index procedure were assessed for the above, including the primary preventive pharmacotherapy prescribed. (3) <b>Results</b>: A total of 1939 patients were reported to have NOCAD. Of these, 1756 (90%) patients (62% males, median age 66 (56–75) years) had no repeat angiography (group 1). Repeat angiography was performed in 10%: 136 (7%) proved futile (median time for repeat angiography 5 (3–8) years) (group 3), and 47 (3%) ended with angioplasty (median time for repeat angiography 4 (3–6) years) (group 2). Male gender, BMI above 30 (23% vs. 13%), hypertension (68% vs. 57%), diabetes (28% vs. 17%) and smoking (36% vs. 19%) were significantly higher in the interventional group. Regression analysis showed both paroxysmal atrial fibrillation and hyperlipidemia were significantly associated with repeat CAG. The indication for the first CAG was mainly symptoms related. In the interventional repeat angiography (<i>n</i> = 47) the incidence of troponin positive cases increased from 8.2% before intervention to 57.5%, 50% being ST elevation cases. The symptoms-related cases went from 36.7% to 18.4%. Intriguingly, 85% of the interventional group were not prescribed statin and/or aspirin on a regular basis, and/or did not adhere to treatment. (4) <b>Conclusions</b>: NOCAD is a frequent occurrence. The threshold for repeat angiography must be higher, better reserved to troponin positive cases. Moreover, patients must be handled according to their risk profile, not being mistakenly reassured by a snapshot benign coronary angiography. |
| first_indexed | 2024-03-08T03:53:52Z |
| format | Article |
| id | doaj.art-9ef7c0f78c674d02b951a0508f49354f |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-08T03:53:52Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-9ef7c0f78c674d02b951a0508f49354f2024-02-09T15:16:34ZengMDPI AGJournal of Clinical Medicine2077-03832024-02-0113387010.3390/jcm13030870Repeat Coronary Angiography in Patients Aged over 50 Years with Previously Normal/Non-Obstructive Coronary Angiogram—Insights from a Retrospective StudyAriel Roguin0Ofer Kobo1Simha-Ron Meisel2Ziad Darawsha3Mahmood Odeh4Aharon Frimerman5Naama Amsalem6Rami Abu Fanne7Department of Cardiology, Hillel Yaffe Medical Center, Affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Hadera 3200003, IsraelDepartment of Cardiology, Hillel Yaffe Medical Center, Affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Hadera 3200003, IsraelDepartment of Cardiology, Hillel Yaffe Medical Center, Affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Hadera 3200003, IsraelDepartment of Cardiology, Hillel Yaffe Medical Center, Affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Hadera 3200003, IsraelEmergency Department, Hillel Yaffe Medical Center, Affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Hadera 3200003, IsraelDepartment of Cardiology, Hillel Yaffe Medical Center, Affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Hadera 3200003, IsraelDepartment of Cardiology, Hillel Yaffe Medical Center, Affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Hadera 3200003, IsraelDepartment of Cardiology, Hillel Yaffe Medical Center, Affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Hadera 3200003, Israel(1) <b>Introduction</b>: A significant proportion of patients undergoing coronary angiography (CAG) have normal (NCA) or non-obstructive coronary artery disease (NOCAD). This study retrospectively tested the incidence of re-catheterization, and long-term outcomes of this population in patients aged over 50 years. (2) <b>Methods</b>: We identified all patients above 50 years of age with NOCAD who underwent their first CAG at our center between January 2008 and December 2019. Patients were evaluated for their baseline characteristics, risk factors profile, and indication for CAG. Patients undergoing repeat CAG after the index procedure were assessed for the above, including the primary preventive pharmacotherapy prescribed. (3) <b>Results</b>: A total of 1939 patients were reported to have NOCAD. Of these, 1756 (90%) patients (62% males, median age 66 (56–75) years) had no repeat angiography (group 1). Repeat angiography was performed in 10%: 136 (7%) proved futile (median time for repeat angiography 5 (3–8) years) (group 3), and 47 (3%) ended with angioplasty (median time for repeat angiography 4 (3–6) years) (group 2). Male gender, BMI above 30 (23% vs. 13%), hypertension (68% vs. 57%), diabetes (28% vs. 17%) and smoking (36% vs. 19%) were significantly higher in the interventional group. Regression analysis showed both paroxysmal atrial fibrillation and hyperlipidemia were significantly associated with repeat CAG. The indication for the first CAG was mainly symptoms related. In the interventional repeat angiography (<i>n</i> = 47) the incidence of troponin positive cases increased from 8.2% before intervention to 57.5%, 50% being ST elevation cases. The symptoms-related cases went from 36.7% to 18.4%. Intriguingly, 85% of the interventional group were not prescribed statin and/or aspirin on a regular basis, and/or did not adhere to treatment. (4) <b>Conclusions</b>: NOCAD is a frequent occurrence. The threshold for repeat angiography must be higher, better reserved to troponin positive cases. Moreover, patients must be handled according to their risk profile, not being mistakenly reassured by a snapshot benign coronary angiography.https://www.mdpi.com/2077-0383/13/3/870normal angiogramnon-significant coronary diseaseatherosclerosisatherothrombosismyocardial infarction |
| spellingShingle | Ariel Roguin Ofer Kobo Simha-Ron Meisel Ziad Darawsha Mahmood Odeh Aharon Frimerman Naama Amsalem Rami Abu Fanne Repeat Coronary Angiography in Patients Aged over 50 Years with Previously Normal/Non-Obstructive Coronary Angiogram—Insights from a Retrospective Study Journal of Clinical Medicine normal angiogram non-significant coronary disease atherosclerosis atherothrombosis myocardial infarction |
| title | Repeat Coronary Angiography in Patients Aged over 50 Years with Previously Normal/Non-Obstructive Coronary Angiogram—Insights from a Retrospective Study |
| title_full | Repeat Coronary Angiography in Patients Aged over 50 Years with Previously Normal/Non-Obstructive Coronary Angiogram—Insights from a Retrospective Study |
| title_fullStr | Repeat Coronary Angiography in Patients Aged over 50 Years with Previously Normal/Non-Obstructive Coronary Angiogram—Insights from a Retrospective Study |
| title_full_unstemmed | Repeat Coronary Angiography in Patients Aged over 50 Years with Previously Normal/Non-Obstructive Coronary Angiogram—Insights from a Retrospective Study |
| title_short | Repeat Coronary Angiography in Patients Aged over 50 Years with Previously Normal/Non-Obstructive Coronary Angiogram—Insights from a Retrospective Study |
| title_sort | repeat coronary angiography in patients aged over 50 years with previously normal non obstructive coronary angiogram insights from a retrospective study |
| topic | normal angiogram non-significant coronary disease atherosclerosis atherothrombosis myocardial infarction |
| url | https://www.mdpi.com/2077-0383/13/3/870 |
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