SPC365

PREDICTORS OF OBSTRUCTIVE CORONARY ARTERY DISEASE IN ELECTIVE CORONARY ANGIOGRAPHY

Session: Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker: Carla Marques Pires

Congress: CPC 2021
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 12. Coronary Artery Disease (Chronic)
Subtheme: 12.3 Coronary Artery Disease – Diagnostic Methods
Session Type: Posters
FP Number: ---
Authors: Carla Marques Pires; Fernando Mané; Cátia Oliveira; Paulo Medeiros; Rui Flores; Rodrigo Siva; João Costa; Catarina Quina; Carlos Braga Galvão; Nuno Antunes; Jorge Marques

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>INTRODUCTION:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In current clinical practice, despite the frequent use of noninvasive test (NIT) in addition to clinical assessment, there is a high percentage of patients(pts) undergoing elective invasive coronary angiography (ICA) with nonobstructive coronary artery disease (CAD).</span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>AIM: </strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">To identify the prevalence and predictors of obstructive CAD in pts undergoing elective ICA without known CAD.</span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>METHODS:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">We performed a cross-sectional study of 358 consecutive pts without known CAD undergoing elective ICA from April 2019 to March &nbsp;2020. Patients demographics, cardiovascular(Cv) risk factors, symptoms status and NIT results were correlated with the&nbsp; presence of obstructive CAD, defined as any native coronary stenosis &ge;50%.</span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>RESULTS:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The study population consisted of 358 pts (72.6% male, mean age 65years), of whom 95% had at least one Cv risk factor and 78.5% had a positive NIT: exercise&nbsp; stress test (36.3%), stress echocardiogram (12.3%), stress cardiac magnetic resonance (3.9%), stress myocardial perfusion imaging (21.8%) or coronary computed tomography angiography (4.2%). </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The overall prevalence of obstructive CAD was 52.8%, which was significantly higher among pts with previous positive NIT (p=0.013). However, 43.8% of pts with positive NIT had nonobstructive CAD.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Pts with obstructive CAD had a mean age of 65 years and were more likely to be male (p&lt;0.001), to have smoking habits (p=0.013), to present with typical angina (p&lt;0.001) and to have positive NIT tests (p=0.013). As expected, this pts were less likely to present with noncardiac chest pain (p&lt;0.001) compared to non-obstructive CAD pts.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In multivariate analysis, male gender (OR=3.4,p&lt;0.001) and typical angina (OR=3.8,p&lt;0.001) were independent predictors (IP) of obstructive CAD. Surprisingly, positive NIT failed to reach statistical significance by a narrow margin (OR=1.7, P=0.06). &nbsp;The presence of non-cardiac chest pain (OR=2.4,p=0.007) was an IP of nonobstructive CAD.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In our study, 72 pts (20.1%) were submitted to percutaneous coronary intervention and 48 pts (13.4%) were proposed to coronary artery bypass surgery considering angiographic characteristics.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The IP of the decision of revascularization were male gender (OR=4.7,p&lt;0.001), typical angina (OR=4.6,p&lt;0.001) and positive NIT (OR=2.1, P=0.04). Presence of noncardiac chest pain (OR=3.3, p=0.08) was an IP of the decision of nonrevascularization.</span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>DISCUSSION:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Nearly half of pts referred to elective ICA are found to have nonobstructive lesions. </span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In our sample, clinical status was much stronger predictor than positive NIT results.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Noteworthy that pts with positive NIT and nonobstructive disease could represent false-positive test or microvascular disease.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In conclusion, current strategies that are used to refer pts to ICA need to be substantially improved to increase the diagnostic yield of this invasive exam.</span></span></p>