The Patient Journey in Chronic Coronary Syndromes with/without Obstructive Coronary Arteries.

Abstract

Background: In patients undergoing invasive coronary angiography for the investigation of angina, the management pathways for obstructive coronary artery disease (CAD) are well described, whereas the clinical and diagnostic journey of patients with ANOCA has largely been inferred, as there is limited quantitative data.

Objectives: To compare the journey of patients with ANOCA versus Obstructive CAD, particularly in relation to (i) clinical presentation and (ii) diagnostic assessment, (iii) 12 month patient-reported outcome measures (PROMs) and (iv) three year composite MACE.

Methods: A total of 2,285 ANOCA and 4,087 Obstructive CAD consecutive patients were included from the CADOSA (Coronary Angiogram Database of South Australia) registry between 2012-2018.

Results: At presentation for elective invasive angiography, the chest pain features and non-invasive ischemic markers were indistinguishable between patients with Obstructive CAD and ANOCA, although the latter were younger (67±11 vs. 61 ± 11 years, p<0.001), more likely to be female (27% vs. 58%, p<0.001) and have fewer traditional cardiac risk factors. However, following angiography (compared to those with Obstructive CAD) patients with ANOCA were less likely to attain a cardiac discharge diagnosis (100% vs. 22%) or receive anti-anginal therapy (76% vs. 57%), despite the same prevalence of persistent angina (weekly angina: 10% vs 11% over 12 months).

Conclusions: Although the pre-angiography journey (symptoms & non-invasive ischemic investigations) of patients with Obstructive CAD and ANOCA is indistinguishable, the post-angiography journey is portrayed by a vast diagnostic and treatment gap in those with ANOCA, which needs to be addressed.