Open AccessThe utility of a ‘non‐significant’ coronary angiogram
Author(s) -
Wang T. K. M.,
Oh T. H. T.,
Samaranayake C. B.,
Webster M. W. I.,
Stewart J. T.,
Watson T.,
Ellis C.,
Ruygrok P. N.
Publication year - 2015
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/ijcp.12723
Subject(s) - medicine , chest pain , coronary artery disease , cardiology , angiography , aspirin , stenosis , atheroma , cohort , radiology
Summary Background Coronary angiography is the gold standard for assessing coronary artery disease ( CAD ). In many patients with chest pain, no or mild CAD (< 50% stenosis) is found. It is uncertain whether this ‘non‐significant’ result influences management and outcomes. We reviewed characteristics and outcomes in a contemporary cohort of chest pain referrals who had mild or absent CAD on coronary angiography. Method All patients undergoing coronary angiography at Auckland City Hospital during July 2010–October 2011 were reviewed ( n = 2983). Of these, 12.3% ( n = 366) underwent coronary angiography for evaluation of chest pain and were found to have absent or mild CAD . These patients were followed up for 2.3 ± 0.6 years. Results Mean age was 60.0 ± 12.3 years, 56.1% were female. The ECG was abnormal in 55.0% of patients. Stress testing for inducible ischaemia was undertaken in 40.7% of patients and was abnormal in 57.7%. Following angiography, 43.2% had no changes to cardiac medications. Additional drug therapy (aspirin, statin, beta‐blockers, ACE ‐inhibitor) was commenced in around 14.2–22.1% of cases. These drugs were discontinued in 4.1–8.2% of patients. Rates of major adverse cardiovascular events and readmissions with chest pain were 0.3% (1) and 1.9% (7) respectively at 30 days, and 1.9% (7) and 6.0% (22) at 1 year. Conclusion Although even non‐obstructive atheroma may justify medical therapy to limit disease progression, our findings may suggest that in these cases, invasive coronary angiography, may not lead to the patient/physician reassurance justified by historical data.