Predictors of Angiographically Normal Coronary Arteries in Stable Patients with Suspected Coronary Disease

Introduction: Coronary angiography (CA) is the gold standard test to identify patients with coronary artery disease. Despitea proportion of normal CAs is expected, this study should be minimized, given its invasive nature, the associated risk andincreased health costs.Objectives: The aim of this study was to establish the characteristics, epidemiological patterns and variables associated toangiographically “normal” coronary arteries in stable patients referred for CA.Methods: Coronary angiographies were analyzed in 12,686 patients from five centers in Buenos Aires. All data were retrospectivelyobtained from 2008 to 2013. Coronary angiographies with < 50% lesions were defined as “normal”. Demographiccharacteristics, usual risk factors, chronic renal failure, hypothyroidism, peripheral vascular disease, symptoms, ischemiainducingtests and social coverage were compared between the group with “normal” CA and patients with ≥ 50% obstructivecoronary disease.Results: Among the 3,990 patients included in the study (31.5%), 38.6% had a normal CA, and female gender was the mostimportant independent predictor for this finding. In addition, younger age and absence of ischemic symptoms were associatedwith greater probability of “normal” CA.Conclusions: In a population referred for CA diagnosed with stable coronary artery disease, female gender, younger age andabsence of symptoms were associated with angiographically “normal” coronary arteries. Better use of clinical stratificationmodels could optimize CA performance to detect patients with significant coronary artery disease, limiting unnecessary studies.