Is Normal Coronary Arteries on Coronary Angiogram Truly Benign?
04 May 2018 (online)
Background Heart disease is the leading cause of death in the world, and coronary angiography (CAG) is the standard test for detection of critical diseases. Nearly 25% patients undergoing angiography are found to have normal coronary arteries (NCAs). Recent publications say that the follow-up of the NCA patients is not benign.
Aim The main objective of this study is to know outcomes of patients diagnosed with normal coronaries on conventional angiograms.
Methods This is a single-center observational study. The authors collected the data of patients who came for CAG to their institute from January 1 to December 31, 2014. They included the patients who have normal coronaries in this study. The indication to do the CAG is chest pain (angina) for evaluation. The authors contacted every patient telephonically to know the outcomes after 2 years of CAG. The telephonic data were collected either from patients or from attendants by asking the questionnaire about the present status of patients.
Results The authors collected the data of 1,526 patients who underwent the CAG during study period. Out of 1,526 patients, 201 patients with mean age of 52.45 ± 10.7 years met the inclusion criteria; 108 (53.73%) were hypertensives and 57 (28.36%) were diabetic. Acute coronary syndrome (ACS) was the presenting symptom in 28 (13.9%) of patients; the remaining patients presented with chronic stable angina (CSA). Left ventricular (LV) dysfunction was present in 15 (7.5%) of patients. At the 2-year follow-up, 12 (5.9%) patients were symptomatic, and out of them, 7 died (mortality 3.5%).
The binary logistic regression showed that only blood urea (BU) was determinant factor for mortality (p = 0.022). Even LV dysfunction (p = 0.39) was not a contributor for mortality. A subanalysis of gender also showed similar findings (male, p = 0.02; female, p = 0.05).
Conclusion In angina patients with NCA on CAG, the BU showed statistical significance for morality. This is true even on further sex-based analysis (male, p = 0.02; female, p = 0.05). This study helps understand that even the people with normal coronaries, they may have the symptomatic outcomes, not only because of coronaries and also with other associated diseases.
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