DETECTION, EXTENT, AND TEMPORAL TRENDS OF OBSTRUCTIVE CORONARY ARTERY DISEASE AMONG PATIENTS UNDERGOING ELECTIVE CARDIAC CATHETERIZATION IN BRITISH COLUMBIA

2014 ◽  
Vol 30 (10) ◽  
pp. S90
Author(s):  
A. Fung ◽  
R. Zhang ◽  
R. Boone ◽  
A. Chan ◽  
A. Della Siega ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
British Columbia ◽  
Coronary Artery ◽  
Cardiac Catheterization ◽  
Obstructive Coronary Artery Disease ◽  
Temporal Trends ◽  
Artery Disease

Abstract 20047: Validation of the Simple Acute Coronary Syndrome (SACS) Score for Identifying Obstructive Coronary Artery Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Daniel Matta ◽  
Christina Marsalisi ◽  
Wayne Ruppert ◽  
Ravi Korabathina
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Cardiac Catheterization ◽  
Obstructive Coronary Artery Disease ◽  
Retrospective Chart Review ◽  
Study Endpoint ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
Scoring Tool

Background: Each year, up to 136,000 individuals suffering from acute coronary syndrome (ACS) are misdiagnosed and discharged from our nations’ emergency departments. We developed the Simple Acute Coronary Syndrome (SACS) score that tabulates a patient’s symptoms, ECG findings, risk factors, and cardiac markers (Figure 1). Our aim was to validate this novel scoring tool in its ability to identify the presence of obstructive coronary artery disease (CAD). Methods: A single-center retrospective chart review was performed after institutional review board approval. The charts of 42 consecutive patients who presented with ACS and who were treated with an invasive strategy were reviewed. Scores were calculated for each patient using the SACS tool as well as the Modified Thrombolysis in Myocardial Infarction (TIMI) ACS calculator. The study endpoint was the presence of at least one vessel obstructive CAD at cardiac catheterization. Descriptive statistics were employed. Results: The stratification of SACS and Modified TIMI scores for each of the 42 ACS patients is shown in Figure 2. In patients with a SACS score that was less than 3, none of these patients were found to have obstructive CAD at cardiac catheterization. For patients with a SACS score of 4 or higher, 100% of these patients were shown to have obstructive CAD. For patients with Modified TIMI scores of 1 and 2, 3/11 (27%) were found to have obstructive CAD. Conclusions: The novel SACS scoring system identifies ACS patients who will have obstructive CAD more reliably than more traditional scoring systems. The SACS scoring tool needs to be validated in larger scale studies.

Abstract P151: Diagnostic Yield of Elective Cardiac Catheterization After an Abnormal Stress Test: A Quality Initiative Study

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Manjunath G Raju ◽  
Srikar Sidini ◽  
Joseph Gardiner ◽  
Ameeth Vedre ◽  
George S Abela
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiac Catheterization ◽  
Diagnostic Yield ◽  
Stress Test ◽  
Obstructive Coronary Artery Disease ◽  
Noninvasive Testing ◽  
Noninvasive Test ◽  
Artery Disease

Background: Guidelines for triaging patients for cardiac catheterization recommend a risk assessment and noninvasive testing. We determined patterns of noninvasive testing and the diagnostic yield of catheterization among patients with suspected coronary artery disease in our outpatient clinical center at Michigan State University. Methods: We conducted a retrospective cohort study of 133 consecutive patients who underwent elective cardiac catheterization from July 2008 through August 2010. Demographic characteristics, risk factors, symptoms and the results of noninvasive testing were correlated with the presence of obstructive coronary artery disease, which was defined as 50% or more of coronary artery stenosis. Results: The median age was 62 years with 71% men. Risk factors included diabetes 39%; hypertension 77 %; prior CAD 44% and dyslipidemia 79 %. Angina/chest pain was present in 62 % and atrial fibrillation in 7%. Patients with prior CAD receiving percutaneous coronary intervention were 34 % (20/58) as compared to 27% (20/75) without prior CAD. Noninvasive testing was performed in 78 % (104/133) of the patients. Among patients undergoing heart catheterization 53% (71/133) had obstructive coronary artery disease. A total of 97 patients had an abnormal stress test and 52% (50/97) had obstructive CAD. Associations with obstructive coronary artery disease were: male sex (odds ratio [OR], 1.51; 95% confidence interval [CI], 0.71, 3.19), older age (OR per 5-year increment, 1.21; 95% CI, 1.03, 1.42), presence of diabetes (OR= 1.51; 95% CI, 0.75, 3.06), and presence of dyslipidemia (OR=1.42; 95% CI, 0.62 to 3.29). Conclusions: Patients with a positive result on a noninvasive test were more likely to have obstructive coronary artery disease than those who did not undergo any testing but this did not achieve significance (52% vs. 48%; P=.76). A larger patient group may be required to confirm this observation. However, improved strategies for risk stratification could help increase the diagnostic yield of cardiac catheterization in routine clinical practice.

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

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sarah Payne ◽  
Ethan Fry ◽  
Jeffrey Michel ◽  
Robert J Widmer
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Statin Therapy ◽  
Cardiac Catheterization ◽  
Patient Population ◽  
Obstructive Coronary Artery Disease ◽  
Angiotensin Ii Receptor Blocker ◽  
Ed Visits ◽  
Artery Disease ◽  
One Year

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.

Gender Differences in Non-Obstructive Coronary Artery Disease

2020 ◽  
Vol 26 ◽  
Author(s):  
Maria Bergami ◽  
Marialuisa Scarpone ◽  
Edina Cenko ◽  
Elisa Varotti ◽  
Peter Louis Amaduzzi ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Gender Differences ◽  
Heart Disease ◽  
Coronary Artery ◽  
Ischemic Heart Disease ◽  
Coronary Arteries ◽  
Obstructive Coronary Artery Disease ◽  
Ischemic Heart ◽  
Current Evidence ◽  
Artery Disease

: Subjects affected by ischemic heart disease with non-obstructive coronary arteries constitute a population that has received increasing attention over the past two decades. Since the first studies with coronary angiography, female patients have been reported to have non-obstructive coronary artery disease more frequently than their male counterparts, both in stable and acute clinical settings. Although traditionally considered a relatively infrequent and low-risk form of myocardial ischemia, its impact on clinical practice is undeniable, especially when it comes to infarction, where the prognosis is not as benign as previously assumed. Unfortunately, despite increasing awareness, there are still several questions left unanswered regarding diagnosis, risk stratification and treatment. The purpose of this review is to provide a state of the art and an update on current evidence available on gender differences in clinical characteristics, management and prognosis of ischemic heart disease with non-obstructive coronary arteries, both in the acute and stable clinical setting.

scholarly journals OCT Findings in MINOCA

2021 ◽  
Vol 10 (13) ◽  
pp. 2759
Author(s):  
Krzysztof Bryniarski ◽  
Pawel Gasior ◽  
Jacek Legutko ◽  
Dawid Makowicz ◽  
Anna Kedziora ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Imaging Modality ◽  
Obstructive Coronary Artery Disease ◽  
Coronary Artery Spasm ◽  
Morphological Characteristics ◽  
Artery Dissection ◽  
Plaque Disruption ◽  
Artery Disease

Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is a working diagnosis for patients presenting with acute myocardial infarction without obstructive coronary artery disease on coronary angiography. It is a heterogenous entity with a number of possible etiologies that can be determined through the use of appropriate diagnostic algorithms. Common causes of a MINOCA may include plaque disruption, spontaneous coronary artery dissection, coronary artery spasm, and coronary thromboembolism. Optical coherence tomography (OCT) is an intravascular imaging modality which allows the differentiation of coronary tissue morphological characteristics including the identification of thin cap fibroatheroma and the differentiation between plaque rupture or erosion, due to its high resolution. In this narrative review we will discuss the role of OCT in patients presenting with MINOCA. In this group of patients OCT has been shown to reveal abnormal findings in almost half of the cases. Moreover, combining OCT with cardiac magnetic resonance (CMR) was shown to allow the identification of most of the underlying mechanisms of MINOCA. Hence, it is recommended that both OCT and CMR can be used in patients with a working diagnosis of MINOCA. Well-designed prospective studies are needed in order to gain a better understanding of this condition and to provide optimal management while reducing morbidity and mortality in that subset patients.

scholarly journals PROGNOSTIC UTILITY OF COMBINED TOTAL CALCIUM SCORE AND NUMBER OF LESIONS IN PREDICTING OBSTRUCTIVE CORONARY ARTERY DISEASE

2021 ◽  
Vol 77 (18) ◽  
pp. 1443
Author(s):  
Venkat Sanjay Manubolu ◽  
Suraj Dahal ◽  
April Kinninger ◽  
Suvasini Lakshmanan ◽  
Francesca Calicchio ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Calcium Score ◽  
Total Calcium ◽  
Prognostic Utility ◽  
Artery Disease
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