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Background: Abnormalities in coronary microcirculation may lead to symptoms of chest pain which mimics angina. Symptoms of chest pain along with evidence of ischemia on non-invasive tests like electrocardiography (ECG), echocardiography or treadmill test (TMT) but with normal coronary angiogram (CAG) is referred to as cardiac syndrome X (CSX). Previous studies have shown favourable prognosis in such patients. However recent studies have not shown good prognosis. We intend to understand whether such adverse cardiovascular outcomes could be secondary to any change in the clinical characteristics of patients with CSX in the current era.Methods: This is a retrospective study which was conducted at a tertiary care hospital. CAG of patients who underwent coronary angiography between November 2013 and October 2016, for suspected ischemic heart disease was reviewed. Clinical characteristics of patients with normal or non-obstructive coronaries (less than 50% stenosis) in angiography with chest pain were analyzed. Further clinical characteristics, ECG, echocardiography, treadmill test and CAG findings were compared among males and females.Results: 410 patients were included in the study. 212 were females and 198 were males. Mean age of presentation was 53.46±10.5 years for males and 55.04±9.3 years for females. Patients presenting with atypical chest pain were higher (70.7%). There were 195 subjects with systemic hypertension, 103 with diabetes mellitus and 57 had dyslipidemia. In the study, most 260 subjects had ST-T changes on ECG. Abnormal echocardiography was seen in only 35 patients. 30.5% patients showed positive stress test for inducible ischemia.Conclusions: CSX is prevalent in significant number of patients who present with symptoms of chest pain. Unlike previous studies, there is no significant difference among males and females, in prevalence and risk factors for this syndrome. Further non-obstructive lesions were found to be higher in females.

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