ANOCA/INOCA/MINOCA: Open artery ischemia

Pepine, Carl J.

doi:10.1016/j.ahjo.2023.100260

Cited by 6 publications

(7 citation statements)

References 23 publications

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“…The cohort was further divided into ANOCA or INOCA 10 when being referred for (atypical) chest pain or angina pectoris symptoms (ANOCA), or whether additional tests (ECG, ergometry, SPECT scan) indicated (suspect) ischemia (INOCA), versus the patients receiving a diagnostic CAG or CT scan due to having a high familial risk or risk factors (other).…”

Section: Methodsmentioning

confidence: 99%

“…The WISE study in women with CAG-detected minimal CAD (≥20% but <50% stenosis) reported an all-cause mortality rate of 1.7%, and cardiac mortality was 1.1% AER over 10 years 25 . Event rates for serious adverse outcomes were recently estimated to be about 3% per year 10 . Notably, each study has slightly different inclusion criteria, as well as different criteria for MACE.…”

Section: Comparability Of Mace Outcomesmentioning

confidence: 99%

“…In the present study, adverse mental health such as anxiety, Type D personality, and hostility were not predictive of MACE, and findings were unclear for depressive symptoms. The differences in findings may be due to several factors: differences in pathophysiological mechanisms in nonobstructive versus obstructive CAD 10 , which are also associated with psychosocial distress 35 , differences in health behavior, age, and sex differences in people with obstructive versus nonobstructive CAD 36 . It is relevant to examine the risk of psychosocial factors for outcomes further stratified for obstructive versus nonobstructive IHD.…”

Section: Psychosocial Factors and Health Status Associated With Macementioning

confidence: 99%

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Psychosocial distress and health status as risk factors for ten-year major adverse cardiac events and mortality in patients with non-obstructive coronary artery disease

Mommersteeg,

Lodder,

Aarnoudse

et al. 2024

Preprint

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Background: Patients with non-obstructive coronary artery disease (NOCAD) experience psychological distress and are at risk for major adverse cardiac events with mortality (MACE). We examined the risk of psychosocial distress, including Type D personality, depressive symptoms, anxiety, positive mood, hostility, and health status fatigue and disease specific and generic quality of life for MACE in patients with NOCAD. Methods: In the Tweesteden mild stenosis (TWIST) study, 546 patients with NOCAD were followed for 10 years to examine the occurrence of cardiac mortality, a major cardiac event, or non-cardiac mortality in the absence of a cardiac event. Cox proportional hazard models were used to examine the impact of psychosocial distress and health status on the occurrence of MACE while adjusting for age, sex, disease severity, and lifestyle covariates. Sex differences and interactions were explored. Results: In total 19% of the patients (mean age baseline = 61, SD 9 years; 52% women) experienced MACE, with an annualized event rate (AER) of 20 events per 1,000 person-years, and a lower risk for women compared to men. Positive mood (HR 0.97, 95%CI 0.95-1.00), fatigue (HR 1.03, 95%CI 1.00-1.06), and physical limitation (HR 0.99, 95%CI 0.98-1.00) were associated with MACE in adjusted models. No significant interactions between sex and psychosocial factors were present. Depressive symptoms were predictive of MACE, but no longer after adjustment. Neither Type D personality, anxiety, hostility, mental health status, or angina frequency and stability were significantly associated with MACE. Conclusions: In patients with NOCAD fatigue, low positive mood, and a lower physical limitation score were associated with MACE, without marked sex differences. Type D personality, psychosocial factors, and health status were not predictive of adverse outcomes. Reducing psychosocial distress is a valid intervention goal by itself, though it is less likely to affect MACE in patients with NOCAD.

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Section: Methodsmentioning

confidence: 99%

Section: Comparability Of Mace Outcomesmentioning

confidence: 99%

Section: Psychosocial Factors and Health Status Associated With Macementioning

confidence: 99%

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Psychosocial distress and health status as risk factors for ten-year major adverse cardiac events and mortality in patients with non-obstructive coronary artery disease

Mommersteeg,

Lodder,

Aarnoudse

et al. 2024

Preprint

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“… 2 This frequency is notably higher among women (around 65%) compared to men (30–50%), and it is estimated to progressively increase in prevalence with the use of non-invasive imaging tests. 3 In the context of the chronic coronary syndrome (CCS), non-obstructive coronary arteries encompass a broad spectrum of clinical phenotypes ranging from angina with non-obstructive coronary arteries (ANOCA) to ischaemia with non-obstructive coronary arteries (INOCA). The latter stems from the mismatch between myocardial oxygen demands and blood supply and it is demonstrable in up to 28% of patients with angina symptoms and functionally non-obstructive coronary artery disease (CAD).…”

Section: Introductionmentioning

confidence: 99%

Vasospastic angina: a review on diagnostic approach and management

Jenkins,

Pompei,

Ganzorig

et al. 2024

Therapeutic Advances in Cardiovascular Disease

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Vasospastic angina (VSA) refers to chest pain experienced as a consequence of myocardial ischaemia caused by epicardial coronary spasm, a sudden narrowing of the vessels responsible for an inadequate supply of blood and oxygen. Coronary artery spasm is a heterogeneous phenomenon that can occur in patients with non-obstructive coronary arteries and obstructive coronary artery disease, with transient spasm causing chest pain and persistent spasm potentially leading to acute myocardial infarction (MI). VSA was originally described as Prinzmetal angina or variant angina, classically presenting at rest, unlike most cases of angina (though in some patients, vasospasm may be triggered by exertion, emotional, mental or physical stress), and associated with transient electrocardiographic changes (transient ST-segment elevation, depression and/or T-wave changes). Ischaemia with non-obstructive coronary arteries (INOCA) is not a benign condition, as patients are at elevated risk of cardiovascular events including acute coronary syndrome, hospitalization due to heart failure, stroke and repeat cardiovascular procedures. INOCA patients also experience impaired quality of life and associated increased healthcare costs. VSA, an endotype of INOCA, is associated with major adverse events, including sudden cardiac death, acute MI and syncope, necessitating the study of the most effective treatment options currently available. The present literature review aims to summarize current data relating to the diagnosis and management of VSA and provide details on the sequence that treatment should follow.

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“…Vasomotor abnormalities, coronary microvascular dysfunction and inflammation are important mechanisms underlying the occurrence of angina pectoris with NO-CAD. There is still very little available research relative to its clinical presentation, which includes: angina with non-obstructive coronary arteries (ANOCA), ischemia with non-obstructive coronary arteries (INOCA), and myocardial infarction with non-obstructive coronary arteries (MINOCA) [4]. The importance of this issue lies not only in the potential of NO-CAD to reduce quality of life [5] and consume enormous health-related resources [6], but also in its ability to increase the risk of major adverse cardiovascular events (MACE) and all-cause mortality [7,8].…”

Section: Introductionmentioning

confidence: 99%

Chemokine Fractalkine and Non-Obstructive Coronary Artery Disease—Is There a Link?

Stangret,

Sadowski,

Jabłoński

et al. 2024

IJMS

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Non-obstructive coronary artery disease (NO-CAD) constitutes a heterogeneous group of conditions collectively characterized by less than 50% narrowing in at least one major coronary artery with a fractional flow reserve (FFR) of ≤0.80 observed in coronary angiography. The pathogenesis and progression of NO-CAD are still not fully understood, however, inflammatory processes, particularly atherosclerosis and microvascular dysfunction are known to play a major role in it. Chemokine fractalkine (FKN/CX3CL1) is inherently linked to these processes. FKN/CX3CL1 functions predominantly as a chemoattractant for immune cells, facilitating their transmigration through the vessel wall and inhibiting their apoptosis. Its concentrations correlate positively with major cardiovascular risk factors. Moreover, promising preliminary results have shown that FKN/CX3CL1 receptor inhibitor (KAND567) administered in the population of patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI), inhibits the adverse reaction of the immune system that causes hyperinflammation. Whereas the link between FKN/CX3CL1 and NO-CAD appears evident, further studies are necessary to unveil this complex relationship. In this review, we critically overview the current data on FKN/CX3CL1 in the context of NO-CAD and present the novel clinical implications of the unique structure and function of FKN/CX3CL1 as a compound which distinctively contributes to the pathomechanism of this condition.

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ANOCA/INOCA/MINOCA: Open artery ischemia

Cited by 6 publications

References 23 publications

Psychosocial distress and health status as risk factors for ten-year major adverse cardiac events and mortality in patients with non-obstructive coronary artery disease

Psychosocial distress and health status as risk factors for ten-year major adverse cardiac events and mortality in patients with non-obstructive coronary artery disease

Vasospastic angina: a review on diagnostic approach and management

Chemokine Fractalkine and Non-Obstructive Coronary Artery Disease—Is There a Link?

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