Beyond coronary anatomy: Rethinking non-obstructive coronary artery disease in the catheterization laboratory

Invasive coronary angiography (ICA) remains the reference standard for defining coronary anatomy.However, its appropriate use in patients with chronic coronary syndromes (CCS) requires careful clinical assessment, while its interpretation should extend beyond the simple distinction between obstructive and non-obstructive coronary artery disease (CAD).In this issue of Polish Heart Journal, Kaziród-Wolski et al. [1] present a nationwide analysis of 749 235 coronary angiographic procedures performed for CCS between 2014 and 2024 in the Polish ORPKI registry.Nearly half of the procedures (49.5%) showed no significant coronary stenosis.Interestingly, the proportion of normal angiograms decreased from 16.4% to 9.3%, whereas non-obstructive CAD increased from 32.4% to 41.4%, leaving the overall proportion of angiograms without significant stenoses relatively unchanged.In multivariable analyses, younger age, female sex, and the absence of traditional cardiovascular (CV) risk factors or previous coronary events were associated with a higher likelihood of normal coronary arteries.Procedural complications were uncommon, although coronary disease extent,