Abstract 16054: Medical Management and Outcomes of Non-obstructive Coronary Artery Disease

Abstract

Introduction: Non-obstructive coronary artery disease (NOCAD) is associated with increased morbidity and higher medical expenses compared to those without NOCAD. Currently there are no set guideline-directed interventions for this patient population. This study examined the management and subsequent cardiovascular (CV) events in those deemed to have NOCAD. Hypothesis: We hypothesized that maximal use of medical therapy would correlate with reduced events. Methods: We undertook a retrospective chart review of 1,752 patients who underwent cardiac catheterization from 10/23/2017 through 10/24/2018 at a tertiary care center. NOCAD was defined as patients underwent cardiac catheterization for ischemic symptoms/testing, but did not receive percutaneous coronary or surgical intervention, were not pre-operative, and had at least one year of follow-up post-catheterization. We obtained medications at the time of catheterization as well as subsequent CV testing and events including hospitalizations and emergency department (ED) visits. Results: Of the 168 patients diagnosed with NOCAD, 12 patients later suffered a CV event including NSTEMI, heart failure exacerbation, or stroke. Of these patients, 41.7% were not been placed on aspirin, statin, beta-blocker (BB), calcium channel blocker (CCB), aldactone, ACE inhibitor (ACEi), or angiotensin II receptor blocker (ARB). In NOCAD patients on statin therapy there was a reduced utilization of CV testing at one year (43.3% vs 58.7%, p=0.04). Furthermore we note a significant reduction in rehospitalizations and ED visits in those on statin (14.5% vs 29.4%, p=0.02) not seen in patients on aspirin (23.8% vs 20.6%, p=0.63), CCB (22.2% vs 25.0%, p=0.76), aldactone (36.7% vs 19.6%, p=0.05), ACEi/ARB (23.1% vs. 22.2%, p=0.90), and even note a significant increase in events in those on BB (30.3% vs 16.3%, p=0.03). Conclusions: While NOCAD is associated with increased morbidity and healthcare utilization, the initiation of statin appears to reduce future CV testing and rehospitalization/ED visits that is not noted with aspirin, BB, CCB, Aldactone, or ACEi/ARB use. Recognition of NOCAD, and initiation of statin therapy could be beneficial in this patient population.