Over 700,000 cases of coronary angiography in stable coronary artery disease based on the ORPKI registry over 11 years - dynamics of changes

Stable coronary artery disease (CAD) is a heterogeneous condition with diverse clinical and pathophysiological characteristics [1]. Nearly 10 million adults in the United States are affected, with an annual risk of 3–4% for myocardial infarction or cardiac death [2]. Diagnostic and therapeutic strategies have evolved with better understanding of optimal revascularization [3]. According to the 2024 ESC guidelines, coronary angiography is recommended in patients with a very high probability of disease, severe or refractory angina, or high event risk [3]. In Poland, 157,430 coronary angiographies were performed in 2023 (4,061 per million inhabitants), 42% in stable angina patients [4].

To identify factors enabling preprocedural qualification of patients with stable CAD for conservative management and to refine indications for invasive diagnostics.

The ORPKI registry includes 158 active interventional cardiology centers across Poland and is supervised by the Association of Cardiovascular Interventions of the Polish Cardiac Society [5].

From 2014–2024, 749,235 coronary angiographies were performed. No significant stenosis was found in 49.5% of cases. The proportion of non-obstructive CAD increased (32.4%→41.4%), while normal angiograms decreased (16.4%→9.3%). Multivessel disease without LMCA involvement declined (23.9%→22.1%) and LMCA-only disease (0.36%→0.23%) (all p<0.001).

Patients qualified for conservative treatment were younger, leaner, and more often women, with lower rates of smoking, prior MI, PCI, CABG, hypertension, diabetes, psoriasis, and kidney disease. In these patients, stroke, dissection, cardiac arrest, and periprocedural death occurred less frequently, while bleeding and allergic reactionswere comparable (Figure 1.).

In multivariable analysis, higher body weight (↑3% per 10 kg) and COPD increased the likelihood of a normal angiogram. Older age (↓22% per 10 years), male sex, diabetes, prior MI, PCI, CABG, smoking, hypertension, kidney disease, and psoriasis reduced it. Predictors of periprocedural complications included single-vessel disease (↑65%), multivessel disease with/without LMCA stenosis (↑72–81%), smoking (↑39%), psoriasis (>3×), and chronic kidney disease (↑48%), while male sex reduced the risk by 34% (Figure 2.).

Non-obstructive atherosclerotic lesions are increasingly recognized. Patients with and without significant stenosis differ in clinical and anthropometric profiles. Body weight and COPD predicted conservative management, while smoking, psoriasis, kidney disease, and multivessel disease increased procedural risk. Male sex was an independent protective factor.For image description, please refer to the figure legend and surrounding text.  For image description, please refer to the figure legend and surrounding text.