The patient journey in chronic coronary syndromes with/without obstructive coronary arteries.

IF 4.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Sarena La, Rosanna Tavella, Jing Wu, John A Spertus, Sivabaskari Pasupathy, Olivia Girolamo, Christopher Zeitz, Matthew Worthley, Margaret Arstall, Ajay Sinhal, John F Beltrame
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引用次数: 0

Abstract

Background and aims: 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 Angina with Non-Obstructive Coronary Arteries (ANOCA) has largely been inferred, as there is limited quantitative data. To compare the journey of patients with ANOCA vs. obstructive CAD, particularly in relation to (i) clinical presentation, and (ii) diagnostic assessment, (iii) 12 month patient-reported outcome measures, and (iv) 3-year composite major adverse cardiovascular events.

Methods and results: A total of 2285 ANOCA and 4087 obstructive CAD consecutive patients were included from the CADOSA (Coronary Angiogram Database of South Australia) registry between 2012 and 2018. At presentation for elective invasive angiography, the chest pain features and non-invasive ischaemic 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).

Conclusion: Although the pre-angiography journey (symptoms and non-invasive ischaemic 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.

Abstract Image

Abstract Image

Abstract Image

慢性冠状动脉综合征伴/不伴阻塞性冠状动脉的患者历程。
背景:在接受有创冠状动脉造影检查心绞痛的患者中,阻塞性冠状动脉疾病(CAD)的治疗途径得到了很好的描述,而ANOCA患者的临床和诊断过程在很大程度上是推断的,因为定量数据有限。目的:比较ANOCA患者与阻塞性CAD患者的历程,特别是(i)临床表现和(ii)诊断评估,(iii) 12个月患者报告的结果测量(PROMs)和(iv) 3年复合MACE。方法:2012-2018年间,从CADOSA(南澳大利亚冠状动脉造影数据库)登记中共纳入2285例ANOCA和4087例阻塞性CAD患者。结果:择期有创血管造影时,阻塞性CAD和ANOCA患者的胸痛特征和非创性缺血标志物难以区分,尽管后者较年轻(67±11岁vs. 61±11岁)。尽管阻塞性CAD和ANOCA患者的血管造影前的旅程(症状和无创缺血性调查)难以区分,但血管造影后的旅程在ANOCA患者中表现出巨大的诊断和治疗差距,这需要解决。
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来源期刊
CiteScore
9.40
自引率
3.80%
发文量
76
期刊介绍: European Heart Journal - Quality of Care & Clinical Outcomes is an English language, peer-reviewed journal dedicated to publishing cardiovascular outcomes research. It serves as an official journal of the European Society of Cardiology and maintains a close alliance with the European Heart Health Institute. The journal disseminates original research and topical reviews contributed by health scientists globally, with a focus on the quality of care and its impact on cardiovascular outcomes at the hospital, national, and international levels. It provides a platform for presenting the most outstanding cardiovascular outcomes research to influence cardiovascular public health policy on a global scale. Additionally, the journal aims to motivate young investigators and foster the growth of the outcomes research community.
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