Abstract 18121: Gaps in Initiation of Evidence-Based Medical Therapies in Patients With Ischemia With Nonobstructive Coronary Artery Disease

Introduction: Ischemia with nonobstructive coronary artery disease (INOCA) is associated with major adverse cardiovascular events (MACE) due to atherosclerotic plaque progression, rupture of high-risk plaque and microvascular dysfunction. While there is evidence for use of ACE inhibitors/ARBs and statins to reduce MACE in patients with coronary artery disease (CAD), gaps in implementation of maximal medical therapy in patients after diagnosis of INOCA is not well described. We hypothesize that cardioprotective medications may be underutilized in patients with INOCA.

Methods: Patients (n=443) with ischemic symptoms associated with ECG changes or troponin rise, no history of CAD and with nonobstructive CAD on noninvasive or invasive coronary assessment between 2010-2021 at Indiana University Health, Indianapolis, were included in this study.

Results: In 226 women and 217 men with mean age 58.5 yrs, 315 underwent invasive angiography and 128 coronary CTA. Compared to baseline, initiation rates of cardioprotective agents were low after INOCA diagnosis for statins (37.9%) and aspirin (ASA, 36.1%) (Figure 1A). Among eligible patients, statins and ASA were underutilized in 42% and 44% respectively. There were no statistically significant differences in prescribing patterns of ASA and statin based on gender or race (Figure 1B).

Conclusions: There are significant gaps in the prescription of cardioprotective medications including statins, ASA, ACEI/ARB and beta blockers in patients with INOCA at a quaternary care hospital. If this pattern is similar to the rest of the country, the factors associated with underutilization of these medications needs to be explored further.