Analysis Of Etiology And Influence Factors Of Patients With Normal Coronary Angiography

Objectives: To explore the etiology and influence factors of patients with normal coronary angiography.To avoid missed diagnosis of patients with normal coronary angiography due to coronary artery related diseases,and to strengthen the differential diagnosis of non-coronary artery diseases that can cause chest pain,reduce misdiagnosis.Methods: A retrospective analysis was made of 35 949 patients who underwent coronary angiography in the Department of cardiology of The First Hospital of Jilin University from January 2013 to May 2018.The patient's name,age,sex,symptoms,surgical records and clinical diagnosis were collected and recorded.According to whether the coronary angiography was normal,the patients were divided into normal group(n=7132)and abnormal group(n=32417).The age and sex of the two groups were compared.Patients with normal coronary angiography were divided into 1 group(age < 45 years old)(n = 875),2 groups(age 45-59 years old)(n = 3784),3 groups(age 60-74 years old)(n = 2295)and 4 groups(age ?75 years old)(n = 178)according to their age.The sex distribution of patients with normal coronary angiography in different age groups was analyzed.According to the main clinical diagnosis of patients with normal coronary angiography,the etiology of patients with normal coronary angiography was classified and analyzed.Result: 1.Of 39549 patients with chest pain who underwent coronary angiography,7132 had normal coronary angiography,the proportion was 18.0%.Patients with normal coronary angiography and the proportion of coronary angiography in the same year from 2013 to 2017,respectively 1034 cases(18.9%),1287 cases(21.0%),1387 cases(20.3%),1269 cases(16.2%)and 1426 cases(15.7%),showed a downward trend.2.The age of normal coronary angiography group was lower than that of abnormal coronary angiography group,the difference was statistically significant(P < 0.001);compared with abnormal coronary angiography group,the proportion of women in normal coronary angiography group was higher,the difference was statistically significant(P < 0.001).3.The patients with normal coronary angiography were grouped according to their age,and the gender distribution was different in groups 1,2,3 and 4.The proportion of males in group 1 was higher than that of females,and that of females in group 2,3 and 4 was higher than that of males,with statistical significance(P < 0.001).4.According to the main clinical diagnosis of patients with normal coronary angiography,its etiology can be divided into two categories: one is coronary artery related diseases,a total of 2067 cases,accounting for 36.6%.The other group was noncoronary artery disease(4525 cases,63.4%).Coronary artery related diseases included 1032 cases of myocardial bridge,911 cases of coronary atherosclerosis,321 cases of unstable angina pectoris,124 cases of acute myocardial infarction,72 cases of coronary heart disease,62 cases of acute coronary syndrome,50 cases of X syndrome,22 cases of coronary artery fistula,abnormal origin,13 cases of variant angina pectoris.Noncoronary artery diseases included:(1)2424 cases of non-coronary cardiovascular diseases;(2)182 cases of respiratory diseases;(3)312 cases of digestive diseases;(4)61 cases of motor nervous system diseases;(5)511 cases of endocrine diseases;(6)790 cases of mental and psychological diseases;(7)245 cases of other diseases.Conclusion: 1.The proportion of patients with normal coronary angiography in our hospital showed a downward trend,and the positive diagnostic rate of coronary angiography increased.2.Women with normal coronary angiography are more common;compared with patients with abnormal coronary angiography,patients with normal coronary angiography are younger.3.The gender distribution of patients with normal coronary angiography is different in different age groups.Male patients are predominant in patients younger than 45 years old,and women are more common in patients older than 45 years old.4.In addition to coronary heart disease,there are many clinical diseases that can cause chest pain,and the cause should be carefully analyzed.Patients with normal coronary angiography can not completely exclude coronary artery disease.For patients with clinical symptoms and signs suggesting that there may be coronary artery disease,appropriate examinations should be selected for further diagnosis to prevent missed diagnosis.At the same time,the differential diagnosis of non-coronary artery diseases which can cause chest pain should be strengthened to reduce misdiagnosis.