Abstract

Patients presenting with typical cardiac chest pain often undergo coronary angiography, but a significant proportion is found to have non-obstructive epicardial coronary arteries. This study aimed to determine the frequency of non-obstructive coronary arteries in patients with typical cardiac chest pain and explore associated risk factors and clinical outcomes. Methods: This retrospective, observational study included patients who presented with typical cardiac chest pain and underwent coronary angiography at S.S. Narayana Heart Centre, Davanagere, Karnataka, between January 2018 and December 2022. Non-obstructive epicardial coronary arteries were defined as the absence of ≥50% luminal narrowing in any major coronary artery. Baseline characteristics, angiographic findings, and clinical outcomes were analyzed. Results: Of the 1,257 patients included, 287 (22.8%) had non-obstructive epicardial coronary arteries. The frequency was higher in women (28.1%) compared to men (17.6%, p < 0.001). Logistic regression analysis identified female sex (odds ratio [OR] 1.84, 95% confidence interval [CI] 1.39-2.44, p < 0.001) and the absence of traditional cardiovascular risk factors (OR 1.62, 95% CI 1.22-2.16, p = 0.001) as significant predictors of non-obstructive coronary arteries. During a median follow-up of 24 months, patients with non-obstructive coronary arteries had a lower rate of major adverse cardiovascular events (MACE) (5.6% vs. 14.3%, p < 0.001), cardiovascular death (0.7% vs. 2.9%, p = 0.032), non-fatal myocardial infarction (2.1% vs. 5.3%, p = 0.017), and revascularization (2.8% vs. 6.2%, p = 0.018) compared to those with obstructive disease. Conclusion: Non-obstructive epicardial coronary arteries were present in nearly one-quarter of patients with typical cardiac chest pain, with a higher frequency in women. Patients with non-obstructive coronary arteries had a more favorable prognosis but may still benefit from tailored diagnostic and management approaches

Description