Abstract
BackgroundSignificant changes in the coronary vessels are not confirmed in a large proportion of patients undergoing cardiac catheterization.AimsThe present study aimed to determine correlates and independent predictors of nonobstructive coronary artery disease (CAD) in older adults referred for elective coronary angiography.MethodsA cross-sectional study was conducted involving 2,214 patients referred to two medical centers (in Poland and Russia) between 2014 and 2016 for elective coronary angiography due to exacerbated angina, despite undergoing optimal therapy for CAD. The median age was 72 years (IQR: 68–76), and 49.5% patients were women.ResultsSignificant stenosis (defined as stenosis of 50% or more of the diameter of the left main coronary artery stem or stenosis of 70% or more of the diameter of the remaining major epicardial vessels) was diagnosed only in 1135 (51.3%) patients. Female sex (odds ratio [OR], 3.01; 95% confidence interval [CI], 2.44–3.72; p < 0.001) and atrial fibrillation (OR, 1.87; 95% CI 1.45–2.40; p < 0.001) were the main independent predictors of nonobstructive CAD. Significantly lower ORs were observed for diabetes (OR, 0.75; 95% CI 0.59–0.95; p = 0.02), chronic kidney disease (OR, 0.76; 95% CI 0.61–0.96; p = 0.02), and anemia (OR, 0.69; 95% CI 0.50–0.95; p = 0.02) after controlling for age, chronic heart failure, BMI, and study center.Discussion and conclusionsThe results confirmed that nonobstructive CAD occurs in a high percentage of older patients referred for elective coronary angiography. This suggests the need to improve patient stratification for invasive diagnosis of CAD, especially for older women and patients with atrial fibrillation.Trial registration number and date of registration: NCT04537507, September 3, 2020.
Highlights
The older population is at an increased risk of coronary artery disease (CAD), the leading cause of morbidity and mortality in developed countries [1]
We do not have data on the medications taken by the patients, the treatment was based on the European Society of Cardiology (ESC) guidelines for atrial fibrillation (AF) and chronic coronary syndrome (CCS) at the time of hospitalization
Our study proved that in the group of older adults who underwent elective diagnostic coronary angiography, the percentage of patients in whom no clinically significant atherosclerotic lesions were detected was very high, i.e., almost 50% of the patients
Summary
The older population is at an increased risk of coronary artery disease (CAD), the leading cause of morbidity and mortality in developed countries [1]. Some positive trends are observed in this respect due to declining physical inactivity and smoking [2], the number of patients with CAD will continue to remain high due to demographic aging and the epidemic of obesity and diabetes [3, 4] This will contribute to the increasing need to undertake therapeutic decisions regarding acute coronary syndromes (ACSs) and stable coronary disease in older patients [5]. Discussion and conclusions The results confirmed that nonobstructive CAD occurs in a high percentage of older patients referred for elective coronary angiography This suggests the need to improve patient stratification for invasive diagnosis of CAD, especially for older women and patients with atrial fibrillation. Trial registration number and date of registration: NCT04537507, September 3, 2020
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