Frequency of Non-Obstructive Coronary Artery Disease in Patients with Non-ST-Segment Myocardial Infarction Taken for Early Invasive Angiography

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Background: Non-ST-segment elevation myocardial infarction (NSTEMI) is a common presentation of acute coronary syndrome, typically managed with early invasive coronary angiography. Objective: To determine the frequency of non-obstructive coronary artery disease in patients with non-ST-segment elevation myocardial infarction undergoing early invasive coronary angiography. Methods: This cross-sectional study was conducted at the Department of Cardiology, NICVD, Karachi, from 14 March 2025 to 14 June 2025. A total of 156 patients aged 40–80 years, diagnosed with NSTEMI, and undergoing early coronary angiography were enrolled through non-probability consecutive sampling. Patients with prior coronary intervention or vasoactive medication use were excluded. Results: Among 156 patients, the mean age was 61.2 ± 9.4 years, and 66.7% were male. Non-obstructive coronary artery disease was observed in 29.5% of patients. NO-CAD was significantly more frequent in females (42.3% vs. 23.1%; p = 0.012). No significant associations were found between NO-CAD and age, BMI, diabetes mellitus, or hypertension. Typical chest pain was more prevalent in patients with obstructive CAD (p = 0.041), while smoking history was also significantly associated with obstructive CAD (p = 0.025). Conclusion: Non-obstructive coronary artery disease is a common finding in NSTEMI patients undergoing early invasive angiography, particularly among females. These results emphasize the need for individualized patient assessment to avoid unnecessary interventions and optimize management strategies. Further large-scale studies are recommended to confirm these findings.

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