Background <p>A substantial number of patients with angina and non-obstructive coronary disease (ANOCA) remain symptomatic despite the absence of flow-limiting lesions, and accumulating evidence suggests an increased risk of adverse outcomes and healthcare utilization. This study aimed to evaluate a simple angiographic index that may reflect myocardial perfusion and correlate with symptom burden in patients with ANOCA.</p> Methods <p>In this cross-sectional study, we enrolled 102 patients with angina and angiographically confirmed non-obstructive coronary artery disease. All patients underwent coronary angiography using a standardized, automated contrast injection protocol. The time for contrast to pass from the left coronary ostium to the coronary sinus (TCPM) was measured fluoroscopically and indexed to myocardial mass, heart rate, and mean arterial pressure, resulting in the indexed Time for Contrast to Pass through the Myocardium (iTCPM). Symptom severity was assessed using the Canadian Cardiovascular Society (CCS) classification and the Seattle Angina Questionnaire (SAQ). Correlations and between-group analyses were performed.</p> Results <p>The mean iTCPM was 4.97 ± 1.02&#xa0;s. iTCPM showed a positive correlation with CCS class (Spearman’s ρ = 0.443, <i>p</i> &lt; 0.00001). iTCPM was inversely correlated with key SAQ scale results including angina frequency (ρ = − 0.460), physical limitation (ρ = − 0.317), and disease perception (ρ = − 0.206). Patients with slower iTCPM demonstrated significantly higher symptom burden.</p> Conclusion <p>The iTCPM offers a simple, quantitative angiographic index that is associated with symptom burden in patients with ANOCA and may reflect altered myocardial contrast transit.</p> Clinical trial number <p>Not applicable.</p>