Clinical InvestigationCoronary Artery DiseasePrevalence and predictors of nonobstructive coronary artery disease identified with coronary angiography in contemporary clinical practice
Section snippets
Data sources
Data from the CathPCI Registry were analyzed for this manuscript. CathPCI Registry is an initiative of the American College of Cardiology Foundation and The Society for Cardiovascular Angiography and Interventions and has been previously described.7, 8 The NCDR CathPCI Registry is a national registry of clinical data and in-hospital outcomes associated with diagnostic cardiac catheterization and percutaneous coronary intervention from more than 1,300 US hospitals. Data elements that include
Prevalence of nonobstructive CAD and baseline characteristics
Nonobstructive CAD (all stenoses <50%) was identified in 58.4% of patients. Of note, 18.3% of patients had evidence of moderate atherosclerosis defined by stenoses between 20% and 49%, whereas 40.1% of patients had minimal or no stenosis (defined by all stenoses <20%). Table I provides baseline characteristics for the study population and for the cohorts with and without obstructive CAD; all comparisons of baseline variables between the 2 cohorts found statistically important differences.
Discussion
The current analysis demonstrates that in a national sample of patients referred for elective coronary angiography, most patients (58%) are found to have nonobstructive CAD. Noninvasive test was used in 64% of patients before referral. Patients with low-risk and intermediate-risk NIT findings were less likely to have obstructive CAD than all others, including patients with no testing before angiography, but obstructive coronary disease was found more often than nonobstructive disease only in
Conclusions
In current clinical practice, most patients undergoing elective invasive angiography have nonobstructive CAD. The diagnostic yield of coronary angiography for obstructive CAD was found to be low, less than 50%, and unchanging from 2009 to 2011. Women and younger patients were more likely to have nonobstructive CAD. Despite guideline recommendations, only two-thirds of patients have an NIT prior to catheterization. This may be, in part, due to the poor performance of NITs in clinical practice,
Disclosures
Funding: This project was sponsored by the Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD, as part of the Cardiovascular Consortium and funded under contract number HHSA290201000007I—Task Order 2, as part of the Research Consortia for Comparative Effectiveness Studies in Cardiovascular Disease. The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for
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Deepak L. Bhatt, MD, MPH served as guest editor for this article.
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D. Dai was responsible for all data analysis.