Zhi Jian Wang1, Lin Lin Zhang1, Sammy Elmariah2, Hong Ya Han1, Yu Jie Zhou3. 1. Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing, China. 2. Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston. 3. Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing, China. Electronic address: azzyj12@163.com.
Abstract
OBJECTIVE: To evaluate the prevalence, clinical characteristics, and risk of cardiac events in patients with nonobstructive coronary artery disease (CAD). PATIENTS AND METHODS: We searched PubMed, EMBASE, and the Cochrane Library from January 1, 1990, to November 31, 2015. Studies were included if they reported prevalence or prognosis of patients with nonobstructive CAD (≤50% stenosis) among patients with known or suspected CAD. Patients with nonobstructive CAD were further grouped as those with no angiographic CAD (0% or ≤20%) and those with mild CAD (>0% or >20% to ≤50%). Data were pooled using random effects modeling, and annualized event rates were assessed. RESULTS: Fifty-four studies with 1,395,190 participants were included. The prevalence of patients with nonobstructive CAD was 67% (95% CI, 63%-71%) among patients with stable angina and 13% (95% CI, 11%-16%) among patients with non-ST-segment elevation acute coronary syndrome. The prevalence varied depending on sex, clinical setting, and risk profile of the population investigated. The risk of hard cardiac events (cardiac death or myocardial infarction) in patients with mild CAD was lower than that in patients with obstructive CAD (risk ratio, 0.28; 95% CI, 0.20-0.38) but higher than that in those with no angiographic CAD (risk ratio, 1.85; 95% CI, 1.52-2.26). The annualized event rates of hard cardiac events in patients with no angiographic CAD, mild CAD, and obstructive CAD were 0.3% (95% CI, 0.1%-0.4%), 0.7% (95% CI, 0.5%-1.0%), and 2.7% (95% CI, 1.7%-3.7%), respectively, among patients with stable angina and 1.2% (95% CI, 0.02%-2.3%), 4.1% (95% CI, 3.3%-4.9%), and 17.0% (95% CI, 8.4%-25.7%) among patients with non-ST-segment elevation acute coronary syndrome. The correlation between CAD severity and prognosis is consistent regardless of clinical presentation of all-cause death, myocardial infarction, total cardiovascular events, and revascularization. CONCLUSION: Nonobstructive CAD is associated with a favorable prognosis compared with obstructive CAD, but it is not benign. The high prevalence and impaired prognosis of this population warrants further efforts to improve the risk stratification and management of patients with nonobstructive CAD.
OBJECTIVE: To evaluate the prevalence, clinical characteristics, and risk of cardiac events in patients with nonobstructive coronary artery disease (CAD). PATIENTS AND METHODS: We searched PubMed, EMBASE, and the Cochrane Library from January 1, 1990, to November 31, 2015. Studies were included if they reported prevalence or prognosis of patients with nonobstructive CAD (≤50% stenosis) among patients with known or suspected CAD. Patients with nonobstructive CAD were further grouped as those with no angiographic CAD (0% or ≤20%) and those with mild CAD (>0% or >20% to ≤50%). Data were pooled using random effects modeling, and annualized event rates were assessed. RESULTS: Fifty-four studies with 1,395,190 participants were included. The prevalence of patients with nonobstructive CAD was 67% (95% CI, 63%-71%) among patients with stable angina and 13% (95% CI, 11%-16%) among patients with non-ST-segment elevation acute coronary syndrome. The prevalence varied depending on sex, clinical setting, and risk profile of the population investigated. The risk of hard cardiac events (cardiac death or myocardial infarction) in patients with mild CAD was lower than that in patients with obstructive CAD (risk ratio, 0.28; 95% CI, 0.20-0.38) but higher than that in those with no angiographic CAD (risk ratio, 1.85; 95% CI, 1.52-2.26). The annualized event rates of hard cardiac events in patients with no angiographic CAD, mild CAD, and obstructive CAD were 0.3% (95% CI, 0.1%-0.4%), 0.7% (95% CI, 0.5%-1.0%), and 2.7% (95% CI, 1.7%-3.7%), respectively, among patients with stable angina and 1.2% (95% CI, 0.02%-2.3%), 4.1% (95% CI, 3.3%-4.9%), and 17.0% (95% CI, 8.4%-25.7%) among patients with non-ST-segment elevation acute coronary syndrome. The correlation between CAD severity and prognosis is consistent regardless of clinical presentation of all-cause death, myocardial infarction, total cardiovascular events, and revascularization. CONCLUSION: Nonobstructive CAD is associated with a favorable prognosis compared with obstructive CAD, but it is not benign. The high prevalence and impaired prognosis of this population warrants further efforts to improve the risk stratification and management of patients with nonobstructive CAD.
Authors: Ryan T Hubbard; Maria C Arciniegas Calle; Sergio Barros-Gomes; Joyce A Kukuzke; Patricia A Pellikka; Rajiv Gulati; Hector R Villarraga Journal: BMC Cardiovasc Disord Date: 2017-08-24 Impact factor: 2.298
Authors: Nitesh Nerlekar; Udit Thakur; Andrew Lin; Ji Quan Samuel Koh; Elizabeth Potter; David Liu; Rahul G Muthalaly; Hashrul N Rashid; James D Cameron; Damini Dey; Dennis T L Wong Journal: Sci Rep Date: 2020-04-28 Impact factor: 4.379
Authors: Floor Groepenhoff; Anouk L M Eikendal; Sophie Heleen Bots; Anne-Mar van Ommen; L M Overmars; Daniek Kapteijn; Gerard Pasterkamp; Johan H C Reiber; David Hautemann; Roxana Menken; Marianne E Wittekoek; Leonard Hofstra; N Charlotte Onland-Moret; Saskia Haitjema; Imo Hoefer; Tim Leiner; Hester M den Ruijter Journal: BMJ Open Date: 2020-12-15 Impact factor: 2.692
Authors: Nina Rieckmann; Konrad Neumann; Sarah Feger; Paolo Ibes; Adriane Napp; Daniel Preuß; Henryk Dreger; Gudrun Feuchtner; Fabian Plank; Vojtěch Suchánek; Josef Veselka; Thomas Engstrøm; Klaus F Kofoed; Stephen Schröder; Thomas Zelesny; Matthias Gutberlet; Michael Woinke; Pál Maurovich-Horvat; Béla Merkely; Patrick Donnelly; Peter Ball; Jonathan D Dodd; Mark Hensey; Bruno Loi; Luca Saba; Marco Francone; Massimo Mancone; Marina Berzina; Andrejs Erglis; Audrone Vaitiekiene; Laura Zajanckauskiene; Tomasz Harań; Malgorzata Ilnicka Suckiel; Rita Faria; Vasco Gama-Ribeiro; Imre Benedek; Ioana Rodean; Filip Adjić; Nada Čemerlić Adjić; José Rodriguez-Palomares; Bruno Garcia Del Blanco; Katriona Brooksbank; Damien Collison; Gershan Davis; Erica Thwaite; Juhani Knuuti; Antti Saraste; Cezary Kępka; Mariusz Kruk; Theodora Benedek; Mihaela Ratiu; Aleksandar N Neskovic; Radosav Vidakovic; Ignacio Diez; Iñigo Lecumberri; Michael Fisher; Balazs Ruzsics; William Hollingworth; Iñaki Gutiérrez-Ibarluzea; Marc Dewey; Jacqueline Müller-Nordhorn Journal: Health Qual Life Outcomes Date: 2020-05-14 Impact factor: 3.186
Authors: Caroline A Berge; Ingeborg Eskerud; Elise B Almeland; Terje H Larsen; Eva R Pedersen; Svein Rotevatn; Mai Tone Lønnebakken Journal: PLoS One Date: 2022-01-21 Impact factor: 3.240