The Association of Severe Coronary Tortuosity and Non-Obstructive Coronary Artery Disease

• Published in: Medicina (Kaunas, Lithuania) Vol. 59; no. 9; p. 1619
• Main Authors: Zebic Mihic, Petra, Saric, Sandra, Bilic Curcic, Ines, Mihaljevic, Ivan, Juric, Iva
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01-09-2023; MDPI
• Subjects: Acute coronary syndromes; Aged; Angina pectoris; Cardiac stress tests; Cardiology; Cardiovascular disease; Chronic illnesses; Comparative analysis; Coronary Angiography; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary heart disease; coronary tortuosity; Coronary vessels; Demographics; Diabetes; Electrocardiography; Family medical history; Female; Heart; Heart attacks; Heart failure; Hospitals; Humans; Hyperlipidemia; Hypertension; Investigations; Ischemia; left coronary dominance; Male; Medical imaging; Middle Aged; Mortality; Myocardial Ischemia; non-obstructive coronary artery disease; Risk factors; Software; Statistical analysis; Vein & artery diseases; women; Womens health; coronary tortuosity; myocardial ischemia; left coronary dominance; non-obstructive coronary artery disease; women
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina59091619

There is an increasing interest in the coronary tortuosity as a novel pathophysiological mechanism of ischemia in coronary artery disease without significant obstruction, but there are a lack of studies to confirm this relationship in the clinical setting. The aim of our study was to evaluate the association of severe coronary tortuosity and the potential role of coronary blood supply dominance in the appearance of myocardial ischemia in patients with non-obstructive coronary artery disease (non-CAD), compared to patients with obstructive coronary artery disease (CAD).
The study enrolled 131 participants (71 male and 60 female), recruited among patients referred to cardiologists due to angina symptoms with ischemic alterations established by cardiac stress tests, as well as those admitted to the hospital for acute coronary syndrome.
Mean age of recruited patients was 61.6 (±10.1) years. According to the coronary angiography, they were divided into two groups: non-obstructive and obstructive CAD (77 and 54, respectively). There were significantly more women (61% vs. 24%,
< 0.001) in the non-CAD group. Both tortuous coronary arteries (50.6% vs. 14.8%,
< 0.001) and left coronary dominance (37.7% vs. 16.7%,
= 0.006) were more frequent in the non-CAD group compared to the CAD group. Female sex (OR = 17.516,
= 0.001), tortuous coronary arteries (OR = 7.962,
= 0.006) and left dominance of blood supply were significant predictors for non-CAD.
Non-obstructive CAD is common among patients, especially women, who are referred for coronary angiography. Severe coronary artery tortuosity is the strongest independent predictor of non-obstructive CAD, followed by female gender and left coronary dominance.