title: The utility of a 'non-significant' coronary angiogram.
abstract: BACKGROUND
  Coronary angiography is the gold standard for assessing coronary artery disease (CAD). In many patients with chest pain, no or mild CAD (< 50% stenosis) is found. It is uncertain whether this 'non-significant' result influences management and outcomes. We reviewed characteristics and outcomes in a contemporary cohort of chest pain referrals who had mild or absent CAD on coronary angiography.
  
  
  METHODS
  All patients undergoing coronary angiography at Auckland City Hospital during July 2010-October 2011 were reviewed (n = 2983). Of these, 12.3% (n = 366) underwent coronary angiography for evaluation of chest pain and were found to have absent or mild CAD. These patients were followed up for 2.3 ± 0.6 years.
  
  
  RESULTS
  Mean age was 60.0 ± 12.3 years, 56.1% were female. The ECG was abnormal in 55.0% of patients. Stress testing for inducible ischaemia was undertaken in 40.7% of patients and was abnormal in 57.7%. Following angiography, 43.2% had no changes to cardiac medications. Additional drug therapy (aspirin, statin, beta-blockers, ACE-inhibitor) was commenced in around 14.2-22.1% of cases. These drugs were discontinued in 4.1-8.2% of patients. Rates of major adverse cardiovascular events and readmissions with chest pain were 0.3% (1) and 1.9% (7) respectively at 30 days, and 1.9% (7) and 6.0% (22) at 1 year.
  
  
  CONCLUSIONS
  Although even non-obstructive atheroma may justify medical therapy to limit disease progression, our findings may suggest that in these cases, invasive coronary angiography, may not lead to the patient/physician reassurance justified by historical data.
authors: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors: T K M
authors: TK
authors: Wang
authors: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors: T H T
authors: TH
authors: Oh
authors: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors: C B
authors: CB
authors: Samaranayake
authors: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.|Department of Cardiovascular Medicine, University of Auckland, Auckland, New Zealand.
authors: M W I
authors: MW
authors: Webster
authors: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors: J T
authors: JT
authors: Stewart
authors: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.|Department of Cardiovascular Medicine, University of Auckland, Auckland, New Zealand.|Department of Cardiology, University of Malaya, Kuala Lumpur, Malaysia.
authors: T
authors: T
authors: Watson
authors: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.|Department of Cardiovascular Medicine, University of Auckland, Auckland, New Zealand.
authors: C
authors: C
authors: Ellis
authors: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.|Department of Cardiovascular Medicine, University of Auckland, Auckland, New Zealand.
authors: P N
authors: PN
authors: Ruygrok
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000000981:diagnostic imaging*; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors