Key result
Invasive coronary angiography confirmed obstructive coronary artery disease in 58.74% of patients referred for suspected stable angina, while 41.26% had no obstructive lesions.
Why the study?
Invasive coronary angiography is the gold standard for diagnosing stable CAD, but a large proportion of patients undergoing angiography do not have obstructive coronary artery disease.
Observational (n=143)
Yes
In a Senegalese cohort with suspected stable angina, over 40% of patients referred for invasive coronary angiography had no obstructive CAD, highlighting the need for improved clinical and non-invasive risk stratification prior to invasive testing.
Questions routine invasive angiography in stable chest pain; leaves open better pre-test selection strategies.
Background: The current gold standard for the diagnosis of stable coronary artery disease (CAD) is invasive coronary angiography. But a large proportion of patients undergoing coronary angiography don’t have obstructive coronary artery disease. Objective: The aim of the present study was to evaluate the diagnostic performance of invasive coronary angiography for patients without known coronary artery disease presenting with stable chest pain syndrome at two hospitals structures in Senegal. Method: We conducted a prospective, descriptive, and analytical study from March 1, 2019, to December 31, 2020 in the Cardiology Departments of General Hospital Idrissa Pouye (HOGIP) and Aristide Le Dantec Hospital (HALD). During the study period a cohort of patients referred to angiography coronary for diagnostic CAD because of suspected stable angina were enrolled. Demographic characteristics, risk factors, symptoms, and noninvasive test results were correlated with the presence of obstructive coronary artery disease. Results: A total of 143 patients were included in our study with a median age of 60.91 ± 10.58 years; men were 96 (67.13%) and women 47 (32.87%). The prevalence of hypertension was 60.84%; diabetes was 34.27%; dyslipidemia was 32.17% and sedentary was 26.57% in our study population. Typical and atypical angina symptoms were present in 37.76% (n = 54) and 49.65% (n = 71) respectively, while 10.49% had dyspnea. Coronary angiography revealed 59 (41.26%) patients with no CAD as well as 27 (18.88%) with one-vessel; 28 (19.58%) with two-vessel, and 29 (20.28%) with three-vessel disease. Independent predictive factors for stable angina with the presence of obstructive lesion were: patient age (OR, 2.36; 95% CI, 1.05 - 5.29; p = 0.036); male gender (OR, 1.6; 95% CI, 0.72 - 3.57; p = 0.24); diabetes (OR, 2.14; 95% CI, 0.96 - 4.75; p = 0.06) and necrosis Q waves (4.75; CI, 0.98 - 23.09; p = 0.05). Conclusion: In our study, more than half of the patients (58.74%) referred for coronary angiography had a confirmed diagnosis. A better clinical and non-invasive assessment is needed to improve the efficiency of patient selection for coronary angiography.
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Hessou et al. (2021) conducted an observational in Suspected stable angina pectoris (n=143). Invasive coronary angiography was evaluated on Presence of obstructive coronary artery disease. Invasive coronary angiography confirmed obstructive coronary artery disease in 58.74% of patients referred for suspected stable angina, while 41.26% had no obstructive lesions.
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