Clinical Insights into The NOCA Syndromes

Background and objectives. This Thesis investigates novel insights into patients undergoing coronary angiography for the assessment of ischaemic symptoms. This research specifically focuses on the clinical features, chest pain characteristics, diagnostic investigations, underlying pathogenesis and outcomes of patients with non-obstructive coronary arteries (NOCA, stenosis <50%). The specific objectives of this Thesis include: Chapter II. To compare the clinical characteristics, discharge diagnosis, 12-month health status and three-year adverse events of patients with and without NOCA. Chapter III. To evaluate ANOCA (angina with NOCA) patients with and without coronary vasomotor disorders. Chapter IV. To identify the clinical determinants at index diagnostic angiography that predict ongoing chest pain in ANOCA patients. Chapter V. To provide an update on the latest evidence available on the sex-specific and ethnicity-specific differences of MINOCA (myocardial infarction with NOCA). Chapter VI. To compare the clinical characteristics and three-year prognosis of suspected MINOCA patients stratified on their cardiac MRI (cMRI) findings. Methods. This Thesis employs multiple methodological approaches. Clinical observational cohort studies were conducted using a clinical cardiac registry (CADOSA- Coronary Angiogram Database of South Australia). Health status measures were derived from the Seattle Angina Questionnaire (SAQ) and collected at baseline (angiography), 1-month and 12-month follow-up. Prognostic outcomes were extracted from administrative records and reviewed. Cross-sectional analyses were age/sex-adjusted where appropriate and multivariate logistic regression was employed for prediction models. Summary of Major Findings. The above study objectives yielded the following findings: Chapter II. In patients undergoing elective invasive coronary angiography for suspected angina, there is a vast gap in the diagnosis and management of these patients depending on the presence or absence of obstructive CAD, despite patients being clinically indistinguishable pre-angiography. Chapter III: Only 6% of ANOCA patients undergo functional coronary angiography to further evaluate the cause of chest pain symptoms. In patients with coronary vasomotor disorders, admissions for unstable angina were three-fold higher, compared to unspecified chest pain patients. Chapter IV: The clinical determinants for chest pain presentation to hospital within one-year post-angiography in an ANOCA population were younger age, chest pain characteristics and a coronary slow flow diagnosis. Chapter V: Women are more susceptible to MINOCA, and ethnicity-specific factors might explain discrepancies in the observed prevalence or underlying pathophysiological mechanisms of MINOCA. However, data regarding these topics are scarce. Chapter VI: Only 20% of suspected MINOCA patients undergo cMRI despite this investigation changing the diagnosis in 49% of patients. Those with a confirmed infarct diagnosis on cMRI had a concerning risk for chest pain presentations and readmissions at three-year follow-up. Conclusions. This Thesis provides novel data on patients with NOCA syndromes, whilst also highlighting the current gaps in care these patients experience. Strategies to employ patient-centred care need to be explored to improve quality of care. This can include changes in policy and practices, investigation of personalised therapy, and harbouring collaborations with patient-consumer groups. This Thesis has highlighted that those with NOCA syndromes should not be overlooked, but instead considered as a new functional coronary heart disease paradigm.

Author dc:creator

• Sarena La, So Duyen

Advisors dc:contributor.advisor

• Tavella, Rosanna
• Beltrame, John F.
• Pasupathy, Sivabaskari

• NOCA Syndrome
• ANOCA
• MINOCA
• Clinical Registry
• Chest Pain

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/2440/151407

OAI identifier oai:identifier

oai:digital.library.adelaide.edu.au:2440/151407