Discrimination between Obstructive Coronary Artery Disease and Cardiac Syndrome X in Women with Typical Angina and Positive Exercise Test; Utility of Cardiovascular Risk Calculators

Abstract

Introduction: Nearly 40% of women with typical angina and a positive exercise tolerance test (ETT) have normal or near normal coronary angiography (CAG) labeled as cardiac syndrome X (CSX). Objective: We performed this study to evaluate the power of common cardiovascular risk calculators to distinguish patients with CSX from those with coronary artery disease (CAD). Methods: 559 women participated in the study. Three risk scores, including (1) newly pooled cohort equation of American College of Cardiology/American Heart Association (ACC/AHA) to predict 10 years risk of first atherosclerotic cardiovascular hard event (ASCVD), (2) Framingham risk score (FRS) for the prediction of 10 years coronary heart disease, and (3) the SCORE tool to estimate 10-year risk of cardiovascular mortality (SCORE), were applied. Results: CAD was diagnosed in 51.5% of the patients. 11.6% of the population had ASCVD < 2.5%, and only 13.8% of these patients had CAD on their CAG. By choosing FRS, 14.4% of patients had FRS < 7.5%, and only 11.3% of these patients had recorded CAD on CAG, while the rest of the patients were diagnosed as CSX. Using the SCORE model, 13.8% of patients had the least value (<0.5%) in whom the prevalence of CAD was 19.9%. The area under receiver operating characteristic curve (AUROC) to discriminate CSX from CAD was calculated for each scoring system, being 0.750 for ASCVD, 0.745 for FRS, and 0.728 for SCORE (p value for all AUROCs < 0.001). The Hosmer–Lemeshow chi squares (df, p value) for calibration were 8.787 (8, 0.361), 11.125 (8, 0.195), and 10.618 (8, 0.224) for ASCVD, FRS, and SCORE, respectively. Conclusions: Patients who have ASCVD < 2.5% or FRS < 7.5% may be appropriate cases for noninvasive imaging (Such as coronary CT angiography). CAG is indicated for patients with ASCVD ≥ 7.5% and FRS ≥ 15%, whereas the patients with intermediate risk need comprehensive patient–physician shared decision-making.

Relationship between increased systemic immune-inflammation index and coronary slow flow phenomenon

“…Coronary slow flow phenomenon (CSFP) is characterized by normal/near-normal epicardial coronary arteries (stenosis < 40%) but delayed vessel opacification in the coronary angiogram (CAG) [1,2]. The prevalence of CSFP in patients undergoing CAG for suspected coronary artery disease (CAD) ranges from 1 to 7% [3].Although studies have shown that inflammation, oxidative stress, diffuse atherosclerosis, microvascular vasomotor and endothelial dysfunction are associated with CSFP [4][5][6][7][8], the exact pathogenesis of CSFP is unknown.…”

A Possible Etiopathogenic Role of Sickle Cell Anemia in Ischemia With Nonobstructive Coronary Arteries

“…MVA, otherwise called cardiac syndrome X, is a diagnosis of exclusion that has been attributed to coronary microvascular dysfunction (CMD) by many studies. [4][5][6][7][8][9][10][11][12] Contributing factors include endothelial dysfunction, inflammation, atherosclerosis, sluggish coronary blood flow, and increased sympathetic output. It has been found that patients with endothelial dysfunction have reduced levels of endothelium-derived nitric oxide (NO) with elevated levels of endothelin-1 (ET-1), resulting in impaired local vasodilatation at capillary beds.…”

“…The patient being discussed had symptoms of typical angina with a positive ETT and a nonobstructive CAD on angiography, which are basic features needed for the diagnosis of INOCA to be made. 4-6, 8, 12 The pain of MVA is described to be generally less responsive to nitrates 4, 5 than that of obstructive CAD. It has been suggested that microvascular dysfunction is not limited to specific vascular beds.…”

Effectiveness of an Educational Program through Mobile Health Application on Knowledge and Adherence to a Healthy Lifestyle in Cardiac Syndrome X Patients

“…Cardiac syndrome X (CSX) is a form of ischemic heart disease (1). Functional coronary microvascular abnormalities are often associated with endothelial dysfunction, resulting in a reduced coronary flow reserve (2,3,4). Moreover, the formation of atherosclerotic plaque inside the wall of the coronary arteries is a hallmark of coronary artery disease (CAD) which leads to the narrowing of the vessels and the clinical manifestations of the acute coronary syndrome, including angina and myocardial infarction (4,5,6).…”