Key result
Only ~3% of older patients with initially non-obstructive disease require angioplasty during repeat angiography.
Why the study?
Many patients undergoing coronary angiography have normal or non-obstructive coronary artery disease, but the incidence of re-catheterization and long-term outcomes in patients over 50 years required evaluation.
What is the incidence and clinical yield of repeat coronary angiography in patients over 50 years old with previously normal or non-obstructive coronary angiograms?
Cohort (n=1,939)
No
What is the incidence and clinical yield of repeat coronary angiography in patients over 50 years old with previously normal or non-obstructive coronary angiograms?
Repeat coronary angiography in patients over 50 with previously non-obstructive disease has a low yield for intervention, highlighting the need for better risk stratification and adherence to preventive pharmacotherapy.
May support selective repeat angiography use; leaves open improved risk stratification and preventive adherence.
(1) Introduction: 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) Methods: 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) Results: 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 (n = 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) Conclusions: 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.
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Roguin et al. (2024) conducted a cohort in Normal or non-obstructive coronary artery disease (NOCAD) (n=1,939). Repeat coronary angiography vs. No repeat angiography was evaluated on Incidence of repeat angiography. Repeat coronary angiography in patients >50 years with initially non-obstructive disease occurred in 10% of cases, but only 3% required angioplasty.
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