Clinical phenotype and patient profile of individuals referred for invasive coronary angiography for chronic coronary syndromes: High prevalence of non-obstructive coronary artery disease and its predictors — a multicenter registry analysis

BACKGROUND: Implementing non-invasive coronary imaging affects the use and distribution of non-obstructive coronary artery disease in coronary angiography (CAG). AIMS: To identify current trends in CAG findings, the clinical phenotype associated with non-significant lesions and predictors of normal angiogram. METHODS: The study included 749 235 CAGs recorded in the National Registry of Procedures of Invasive Cardiology database in Poland (456 202 [61%] were performed on men, with a median age of 67 years). Data were collected between 2014 and 2024 from patients with chronic coronary syndromes. RESULTS: No significant stenosis was found in 49.5% of cases. The frequency of non-obstructive coronary artery disease showed increasing trend (range 32.4%-41.4%), while normal angiograms showed decreasing trend (range 16.4%-9.3%). Multivessel disease (MVD) without left main coronary artery (LMCA) involvement showed decreasing trend (range 23.9%-22.1%) as well as LMCA-only disease (range 0.36%-0.23%). Higher body weight and chronic obstructive pulmonary disease increased the likelihood of normal angiogram. Older age, male sex, diabetes, prior myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, current smoking, hypertension, kidney disease, and psoriasis reduced it. Risk of periprocedural complications during CAG in group referred to conservative treatment have been increased by single-vessel disease (65%), MVD with/without LMCA stenosis (72%-81%), current smoking (39%), psoriasis (over 3-fold), and kidney disease (48%), while male sex reduced the risk by 34%. CONCLUSIONS: Non-obstructive atherosclerotic lesions are increasingly recognized. Groups with and without significant stenosis differ in clinical and anthropometric profiles. Body weight and chronic obstructive pulmonary disease predicted conservative management. Current smoking, psoriasis, kidney disease, and MVD increased procedural risk; male sex decreased it.