Prevalence of coronary microvascular disease and coronary vasospasm in patients with nonobstructive coronary artery disease: systematic review and meta‐analysis

Mileva, N. et al. (2022) Prevalence of coronary microvascular disease and coronary vasospasm in patients with nonobstructive coronary artery disease: systematic review and meta‐analysis. Journal of the American Heart Association, 11(7), e023207. (doi: 10.1161/JAHA.121.023207) (PMID:35301851) (PMCID:PMC9075440)

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Abstract

Background: A relevant proportion of patients with suspected coronary artery disease undergo invasive coronary angiography showing normal or nonobstructive coronary arteries. However, the prevalence of coronary microvascular disease (CMD) and coronary spasm in patients with nonobstructive coronary artery disease remains to be determined. The objective of this study was to determine the prevalence of coronary CMD and coronary vasospastic angina in patients with no obstructive coronary artery disease. Methods and Results: A systematic review and meta‐analysis of studies assessing the prevalence of CMD and vasospastic angina in patients with no obstructive coronary artery disease was performed. Random‐effects models were used to determine the prevalence of these 2 disease entities. Fifty‐six studies comprising 14 427 patients were included. The pooled prevalence of CMD was 0.41 (95% CI, 0.36–0.47), epicardial vasospasm 0.40 (95% CI, 0.34–0.46) and microvascular spasm 24% (95% CI, 0.21–0.28). The prevalence of combined CMD and vasospastic angina was 0.23 (95% CI, 0.17–0.31). Female patients had a higher risk of presenting with CMD compared with male patients (risk ratio, 1.45 [95% CI, 1.11–1.90]). CMD prevalence was similar when assessed using noninvasive or invasive diagnostic methods. Conclusions: In patients with no obstructive coronary artery disease, approximately half of the cases were reported to have CMD and/or coronary spasm. CMD was more prevalent among female patients. Greater awareness among physicians of ischemia with no obstructive coronary arteries is urgently needed for accurate diagnosis and patient‐tailored management.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin
Authors: Mileva, N., Nagumo, S., Mizukami, T., Sonck, J., Berry, C., Gallinoro, E., Monizzi, G., Candreva, A., Munhoz, D., Vassilev, D., Penicka, M., Barbato, E., De Bruyne, B., and Collet, C.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Journal of the American Heart Association
Publisher:American Heart Association
ISSN:2047-9980
ISSN (Online):2047-9980
Published Online:18 March 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in Journal of the American Heart Association 11(7): e023207
Publisher Policy:Reproduced under a Creative Commons License

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