High prevalence of angina with no obstructive CAD observed in females, reveals coronary angiography study

A new investigation found that there was a high prevalence of Angina with no obstructive coronary artery disease (ANOCA) in patients undergoing invasive coronary angiography. Angina with no obstructive coronary artery disease (ANOCA) was stable and was mostly seen in female patients.

The study was published in the Canadian Journal of Cardiology. 

Angina with no obstructive coronary artery disease is a common and under-recognized clinical entity. It's not clear whether the referral patterns for diagnosing chest pain have changed. Hence, researchers conducted a retrospective, population-based cohort study to determine if the prevalence of patients diagnosed with ANOCA with coronary angiography has modified over time. 

 Between 1995 and 2020 Alberta patients who had their first coronary angiogram for a chest pain syndrome were extracted from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database. A temporal trend analysis was performed to compare patients with ANOCA to obstructive coronary artery disease (CAD), and the predictors of ANOCA were investigated. 

Results: 

• 121,066 patients were included, out of which 26% had ANOCA with a mean age of 62 years. There were 31% females in the study.
• The percent of ANOCA to obstructive CAD ranged between 24.2% and 26.7% in all patients (p<0.001), 19.4% and 21.4% in patients with acute coronary syndromes (p=0.002), and 30.6% and 37.5% in patients with stable angina (p<0.001).
• Female sex, younger age, history of atrial fibrillation, and stable angina (versus myocardial infarction; versus unstable angina) were independent predictors of ANOCA. 

• Traditional cardiovascular risk factors were associated with obstructive CAD. 

This study allows excluding obstructive CAD with less invasive testing, especially in females. 

Further reading: Patel S, Fung M, Liang Z, Butalia S, Anderson TJ. Temporal trends of the prevalence of angina with no obstructive coronary artery disease (ANOCA) [published online ahead of print, 2022 Oct 20]. Can J Cardiol. 2022;S0828-282X(22)00977-1. doi: 10.1016/j.cjca.2022.10.018