Abstract 19113: Invasive Evaluation of Chest Pain in Patients With Angiographically Normal Coronary Arteries
Background: More than 20% of patients with angina have no angiographic evidence of coronary artery disease (CAD). Our aim was to investigate alternative etiologies for chest pain in these patients.
Methods: In patients with angina who were referred for coronary angiography and had no angiographic CAD, endothelial function testing, intravascular ultrasound (IVUS), and physiology measurements were performed.
Results: A total of 139 patients were enrolled. The average age was 54.0±11.4, with 107 women (77%). Seventy four patients (53.2%) had hypertension, 32 (23.2%) diabetes, 87 (62.6%) dyslipidemia, 10 (7.2%) tobacco use, and 45 (32.4%) a family history of CAD. Endothelial dysfunction (a decrease in luminal diameter of >20% with intracoronary acetylcholine) was present in 61 patients (43.9%). Five patients (3.6%) had fractional flow reserve <0.80. Microcirculatory impairment (an index of microcirculatory resistance ≥25) was present in 29 patients (20.9%). Myocardial bridging (an echolucent halo found on IVUS with systolic arterial compression >10%) was present in 54 patients (43.9%). Thirty eight patients (27.3%) had no coronary explanation for their chest pain, with normal endothelial function and coronary physiologic assessment, and no myocardial bridging. There was no complication.
Conclusion: Many patients with angina and no angiographic evidence of CAD have occult coronary circulatory abnormalities, while a minority has no coronary etiology to explain their symptoms. A complete invasive assessment of these patients at the time of coronary angiography provides important diagnostic information which may affect treatment.
- © 2013 by American Heart Association, Inc.