Determining the Frequency of Non-Obstructive Coronary Artery Disease in Elective Angiography Cases

Cardiovascular disease particularly ischemic heart disease has emerged as a leading cause of death. Atherosclerosis in epicardium results in CAD without the restriction of coronary circulation but the other processes that may disrupt the myocardial supply and demand in patients exhibiting angina symptoms or indications may be suspected of having non-obstructive CAD. Objective: To �nd out the prevalence of non-obstructive CAD in patients enrolled for elective angiography. Methods: A cross-sectional descriptive analysis was done in the Cardiology department in King Edward Medical University and Mayo Hospital, Lahore. The duration of study was for six months from 01-08-2022 to 01-02-2023. After approval from hospital ethical committee, 150 patients were enrolled in the study with informed written consent. Demographics including Name, age, BMI, confounding factors like (diabetes, hypertension, smoking and family history) and address were noted. All selected patients underwent coronary angiography via right femoral artery approach by a consultant cardiologist. Non-obstructive coronary artery disease was assessed as per operational de�nition. All the information was noted on pre-designed proforma (attached). Results: A total of 150 patients were selected for the study. It showed that out of 150 patients, 2.7% (n=4) fall in age group of 18-40 years and 97.3 % (n=146) were in age group of 41-60 years, average age was 51.94±5.26 years and the BMI was 27.96±6.44 kg/m2. There were 62.7 % (n=94) male and 37.3 % (n=56) females. Frequency of diabetes mellitus was 34.7 % (n=52), hypertension was 24.7 % (n=37), smokers 16.7 % (n=25), family history was 12.7 % (n=19) and frequency of non-obstructive CAD was 27.3 % (n=41). Conclusions: It is to be concluded that a considerable percentage of patients enrolled for elective coronary angiography had non-obstructive CAD.

CAD is mainly recognized by an inadequate supply of blood and oxygen to myocardium.It is caused by blockage of the coronary arteries and due to an imbalance between supply and demand for oxygen.The most important feature is the formation of plaques in coronary artery that hinders the blood ow [1].The atherosclerotic plaque that causes nonobstructive (CAD) is not expected to impede blood ow or cause angina symptoms.Despite the fact that these lesions are rather common-they show up in 10% to 25% of individuals having coronary angiography-the medical literature has labeled their existence as "insigni cant" or "no signi cant CAD [2]."Non-obstructive CAD is easily ignored and left untreated due to its prolonged asymptomatic period and hence increases the risk of abrupt clinical coronary events that resemble those of obstructive CAD [3].Initially, it was believed that nonobstructive CAD was a benign illness, but it is recently discovered that patients with non-obstructive CAD have greater risk of cardiovascular related disease and death [4]

M E T H O D S R E S U L T S
Total 150 patients were selected on the basis of inclusion criteria to nd out the frequency of non-obstructive CAD in patients who undergo for elective angiography.Distribution of demographics showed that out of 150 patients, 2.7 %( n=4) were in age group of 18-40 years and 97.3 %( n=146) were in age group of 41-60 years, average age was calculated as 51.94±5.26years and 62.7 %( n=94) were male and 37.3 %( n=56) were females.Frequency of diabetes mellitus was 34.7 %( n=52).Frequency of hypertension was 24.7 %( n=37).Frequency of smoking was 16.7 %( n=25).Frequency of family history was 12.7 %( n=19).Distribution of BMI was 27.96±6.44kg/m2.Frequency of non-obstructive CAD was 27.3 %( n=41) (Table 1).

THE THERAPIST VOL. 5 Issue 1 Jan-Mar 2024
Copyright © 2024.THE THERAPIST, Published by Crosslinks International Publishers A cross sectional analysis was conducted in the Department of Cardiology in King Edward Medical University and Mayo Hospital, Lahore.The duration of study was for six months from 01-08-2022 to 01-02-2023.Nonprobability consecutive sampling was used to select participants.Study enrolled 150 patients by using WHO sample size calculator with 8% margin of error, 95% con dence level and taking expected prevalence of nonobstructive CAD as 25.8%.Individuals of all genders, aged 18 to 60 years and without the history of cardiovascular disease, were admitted for coronary angiography.Patients with a histor y of myocardial infarction, previous percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) surgery, or the need for emergency or urgent cardiac catheterization were excluded from the study.After approval from hospital ethical committee (ref no.CPSP/REU/CRD-2020-066-2407, dated 30-07-2022), 150 patients were enrolled in the study, presenting in department of Cardiology, KEMU/ Mayo Hospital, Lahore with informed written consent.Demographics including Name, age, BMI, confounding factors like (diabetes, hypertension, smoking and family history) and address were noted.All selected patients underwent coronary angiography via right femoral artery approach by a consultant cardiologist.Non-obstructive CAD was assessed as per operational de nition.All the information was noted on pre-designed proforma (attached).All the data were analyzed by using SPSS version 28.0.Numerical variables like age and BMI were calculated as mean + S.D. Frequency and percentage were calculated for qualitative The data for age, gender, diabetes mellitus, hypertension, smoking, family history was strati ed by using chi-square test (Table 2).Family history had a signi cant difference( p=0.000) gender (p=0.187),hypertension (p=0.678),Body mass index (p=0.415),diabetes mellitus (p=0.565),age group (p=0.301), and smoking status (p=0.221) had nonsigni cant differences.
. The 2013 guidelines for Stable Coronary Artery Disease (ESC-SCAD) from the European Society of Cardiology suggested non-obstructive CAD as a distinct kind of CAD [5].It is discovered that approximately 40% of all individuals who undergo angiography are known to have variables like age group, gender, hypertension, diabetes mellitus, family history, smoking and non-obstructive coronary artery disease.Data for age, BMI, gender, diabetes mellitus, hypertension, smoking, family history were strati ed.After the strati cation, chi-square test was used to determine p value(less than 0.05 as signi cant).non-obstructivecoronaryCADor normal coronary arteries.This is a group that, despite its great incidence, is rarely given a clear diagnosis, is commonly mislabeled and managed inappropriately, and, for the most part, still exhibits symptoms[6].According to a research by Iqbal et

Javaid HMR et al.,
Prevalence of Non-Obstructive Coronary Artery Disease

DOI:https://doi.org/10.54393/tt.v5i01.202 Frequency(%) Variables
Copyright © 2024.THE THERAPIST, Published by Crosslinks International Publishers revealed that women are twice as likely as men to get a nonfatal MI if they experience non-speci c chest discomfort[21].The possible contributing factors may be the women have worse mental health and physical state, a lower degree of interstitial brosis, and a lower frequency of Javaid HMR et al.,

Table 2 :
Strati cation for non-obstructive coronary artery disease with respect to age group(N= 150)