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Background  Normal or near‐normal coronary arteries ( NNCAs ) or nonobstructive coronary artery disease ( CAD)  are found on invasive coronary angiography in ≈55% of patients. Some attribute this to frequent referral of low‐risk patients. We sought to identify the referral indications, pretest risk, key clinical characteristics, sex, and outcomes in patients with  NNCAs  and nonobstructive  CAD  versus obstructive  CAD  on nonemergent invasive coronary angiography.    Methods and Results  Over 24 months, 925 consecutive patients were classified as having  NNCAs  (≤20% stenosis), nonobstructive  CAD  (21–49% stenosis), or obstructive  CAD  (≥50% stenosis). Outcomes included cardiac death, nonfatal myocardial infarction ,  and late revasclarization.  NNCAs  were found in 285 patients (31.0%), nonobstructive  CAD  in 125 (13.5%), and obstructive  CAD  in 513 (55.5%).  NNCAs  or nonobstructive  CAD  was found in 40.5% with stress ischemia, 27.9% after a non‐ST‐elevation myocardial infarction, and in 55.5% with stable or unstable angina. More women than men (53.5% versus 37.2%;  P <0.001) had  NNCAs  or nonobstructive  CAD  across all referral indications. Pretest risk was high and  ICA  appropriate in 75.5% and 99.2% of patients, respectively. Annual rates of cardiac death or nonfatal  myocardial infarction  were 1.0%, 1.1%, and 6.7%, respectively, for patients with  NNCAs , nonobstructive  CAD , and obstructive  CAD  ( P <0.001). No sex differences in outcomes were observed with either  NNCAs , nonobstructive  CAD,  or obstructive  CAD  ( P =0.84).    Conclusions  Many (44.5%) patients undergoing nonemergent invasive coronary angiography have  NNCAs  or nonobstructive  CAD  despite high pretest risk, including ischemia and troponin elevation. Although women had more  NNCAs  or nonobstructive  CAD , there were no differences in event rates by sex. Patients with  NNCAs  and nonobstructive  CAD  had very low event rates.

journal of the american heart association

Clinical Characteristics, Sex Differences, and Outcomes in Patients With Normal or Near‐Normal Coronary Arteries, Non‐Obstructive or Obstructive Coronary Artery Disease