Temporal changes in the pattern of invasive angiography use and its outcome in suspected coronary artery disease: implications for patient management and healthcare resources utilization.
Introduction
Invasive coronary angiography (CAG), the 'gold standard' in coronary artery disease (CAD) diagnosis, requires hospitalization, is not risk-free, and engages considerable healthcare resources.


Aim
To assess recent (throught out 10 years) evolution of 'significant' (≥ 50% stenosis(es)) CAD prevalence in subjects undergoing CAG for CAD diagnosis in a high-volume tertiary referral center.


Material and methods
Anonymized medical records were compared for the last vs. the first 2-years of the decade (June 2007 to May 2018). Referrals for suspected CAD were 2067 of 4522 hospitalizations (45.7%) and 1755 of 5196 (33.8%) respectively (p < 0.001).


Results
The median patient age (64 vs. 68 years) and the prevalence of heart failure (24.1% vs. 42.2%) increased significantly (p < 0.001). The CAG atherosclerotic lesions, for all stenosis categories (< 50%; ≥ 50%; ≥ 70%; occlusion(s)), were significantly more prevalent in men. The proportion of subjects with any atherosclerosis on CAG increased (80.7% vs. 77.6%, p = 0.015). However, in the absence of any gross change in, for instance, the fraction of women (40.4% vs. 41.8%), the proportion of CAGs with significant CAD (lesion(s) ≥ 50%) decreased from 55.2% in 2007/2008 to below 1 in every 2 angiograms (48.9%) in 2017/2018 (p < 0.001). This unexpected finding occurred consistently across nearly all CAG referral categories.


Conclusions
Despite more advanced age and a higher proportion of subjects with 'any' coronary atherosclerosis on CAG, the likelihood of a 'negative' angiogram (lesion(s) < 50%; no further evaluation/intervention) has increased significantly over the last decade. The exact nature of this phenomenon requires further investigation, particularly as a reverse trend would be expected with the growing role (and current high penetration) of contemporary non-invasive diagnostic tools to rule out significant CAD.
['Chmiel|Jakub|J|', 'Książek|Miłosz K|MK|', 'Stryszak|Weronika|W|', 'Iwaszczuk|Paweł|P|', 'Hołda|Mateusz K|MK|', 'Świtacz|Grażyna|G|', 'Kozanecki|Artur|A|', 'Wilkołek|Piotr|P|', 'Rubiś|Paweł|P|', 'Kopeć|Grzegorz|G|', 'Odrowąż-Pieniążek|Piotr|P|', 'Przewłocki|Tadeusz|T|', 'Tracz|Wiesława|W|', 'Podolec|Piotr|P|', 'Musiałek|Piotr|P|']
angiography coronary artery disease coronary angiography diagnosis coronary angiogram invasive evaluation