Rate, clinical and management characteristics of patients with chronic non-obstructive coronary artery disease (NOCAD)
DOI:
https://doi.org/10.52692/1857-0011.2025.1-81.05Keywords:
non-obstructive CAD rate, coronary functional testingAbstract
Purpose: To assess the rate of non-obstructive CAD among patients with stable coronary artery disease and to evaluate the clinical, diagnostic and treatment features of this population. Material and Methods: The operative protocols and medical records of 3,200 patients who underwent coronary angiography in two cardiac catheterization centers in Moldova between January 1 and August 1, 2024, were analyzed to determine the rate of non-obstructive CAD. Clinical, demographic, diagnostic, and treatment data were collected from 200 consecutive patients with non-obstructive CAD. Results: The calculated rate of non-obstructive CAD was 43.4%, with a female predominance of 61%. The mean age of patients was 64.7±8.8 years. The most common risk factors were hypertension (87%) and dyslipidemia (73%), while diabetes mellitus was diagnosed in 26%. Only 47% of patients reported typical angina pain, and just 23% had objective evidence of ischemic changes on non-invasive testing. Microvascular angina was diagnosed in 69% of cases, and vasospastic angina in 6%. Antianginal treatment included beta-blockers (69%), calcium channel blockers (52%), nitrates (4%), and trimetazidine (8%). Baseline therapy included ACE inhibitors (77%), statins (72%) and antiplatelets (49%). Conclusions: The rate of non-obstructive CAD evaluated in two PCI centers in Moldova was 43.4%, with a predominance of women accounting for 61%. The diagnosis of non-obstructive CAD presents a challenge for clinicians due to the atypical clinical presentation (typical anginal pain in only 47% of cases), non-informative non-invasive tests (objective evidence of ischemic changes detected non-invasively in 23% of cases), and the unavailability of invasive coronary testing.
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