Determinants of long-term clinical outcomes in patients with angina but without obstructive coronary artery disease: a systematic review and meta-analysis

Radico, Francesco; Zimarino, Marco; Fulgenzi, Fabio; Ricci, Fabrizio; Nicola, Marta Di; Jespersen, Lasse; Chang, Su Min; Humphries, Karin H.; Marzilli, Mario; Caterina, Raffaele De

doi:10.1093/eurheartj/ehy185

Cited by 122 publications

(98 citation statements)

References 77 publications

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“…Occlusive coronary spasm can be found in patients with transient ST-segment elevation with or without angiographically visible stenosis, and is more typical of women. Coronary microvascular dysfunction is more commonly found in people, again more often women, with angina, signs of myocardial ischemia and no obstructed coronary arteries [ 20 ]. A rare MI cause, almost exclusive to young women, is coronary dissection, a nonatherosclerotic coronary disease often associated with fibromuscular dysplasia [ 21 ].…”

Section: Risk Factors and The Precipitating Mechanisms Of Myocardial mentioning

confidence: 99%

“…On the other hand, when microvascular dysfunction and vasoconstriction predominate, specific drug therapy is indicated. It is not uncommon that women with angina and no or nonobstructive coronary artery disease undergo repeated coronary angiographies each time they present with a non-ST-elevation type of acute coronary syndrome (ACS), and even in the case of stable angina [ 20 ].…”

Section: Risk Factors and The Precipitating Mechanisms Of Myocardial mentioning

confidence: 99%

“…The most likely reason why the data on outcome have been so conflicting is the relatively low rate of death and MI at follow-up among patients (mostly women) with angina and no obstructive coronary disease. The largest meta-analysis on this issue [ 20 ] identified 54 studies, reporting outcomes in a total of 35 039 patients (mean age 56, male/female ratio 0.51) with angina and no obstructive CAD. After a median follow-up of 5 years, the pooled incidence of death and MI was 0.98/100 person-years [95% confidence interval (CI) 0.77-1.19%], that is less than 1% per year.…”

Section: Perimenopause Vasomotor Symptoms and Vascular Diseasementioning

confidence: 99%

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Perimenopause vasomotor symptoms, coronary atherosclerosis and risk of myocardial infarction during menopause: the cardiologist’s perspective

Savonitto

Ferri

Colombo³

2018

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Myocardial infarction (MI) is rare in pre-menopausal women, and in most cases has a gender-specific pathogenesis. After menopause, MI incidence increases gradually to equalize men’s rate in the eighth decade of age, with similar pathogenesis. This epidemiological observation has raised a number of hypotheses on the protective effect of estrogen against atherosclerosis and its related diseases. However, MI has a multifactorial pathogenesis with variable contributions of inflammation, eroded or ruptured atherosclerotic plaques, vasoconstriction and thrombosis. Whether perimenopausal vasomotor symptoms are associated with a better, worse or neutral effect on the risk of myocardial infarction has long been disputed. The recent finding of the LADIES ACS study that women reporting transitional vasomotor symptoms have earlier onset myocardial infarction, as compared to women without symptoms, despite similar risk factors and extent of coronary angiographic disease, supports the hypothesis that endothelial dysfunction, or other vasoconstrictive mechanisms, may play a key role in precipitating an acute coronary syndrome at an earlier age. These factors, rather than other atherosclerotic markers, should be specifically investigated in order to elucidate the so far elusive link between vasomotor symptoms and risk of MI.

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Section: Risk Factors and The Precipitating Mechanisms Of Myocardial mentioning

confidence: 99%

Section: Risk Factors and The Precipitating Mechanisms Of Myocardial mentioning

confidence: 99%

Section: Perimenopause Vasomotor Symptoms and Vascular Diseasementioning

confidence: 99%

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Perimenopause vasomotor symptoms, coronary atherosclerosis and risk of myocardial infarction during menopause: the cardiologist’s perspective

Savonitto

Ferri

Colombo³

2018

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“…The clinical importance of angina recurrence following successful PCI is evident from developments in clinical quality registries, where post-PCI angina is being utilized as a clinical performance marker for PCI (16). Despite this, while prospective studies have documented that angina, including with inducible ischaemia, is a contributing factor in many patients with chest discomfort symptoms post-PCI (17), few studies have systematically addressed the mechanisms responsible for the recurrent angina (18,19) and there are no comprehensive recommendations for its diagnosis or treatment (1,20). Figure 2).…”

Section: Introductionmentioning

confidence: 99%

Mechanisms and diagnostic evaluation of persistent or recurrent angina following percutaneous coronary revascularization

Crea

Merz

Beltrame

et al. 2019

European Heart Journal

104

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Persistence or recurrence of angina after a percutaneous coronary intervention (PCI) may affect about 20–40% of patients during short–medium-term follow-up. This appears to be true even when PCI is ‘optimized’ using physiology-guided approaches and drug-eluting stents. Importantly, persistent or recurrent angina post-PCI is associated with a significant economic burden. Healthcare costs may be almost two-fold higher among patients with persistent or recurrent angina post-PCI vs. those who become symptom-free. However, practice guideline recommendations regarding the management of patients with angina post-PCI are unclear. Gaps in evidence into the mechanisms of post-PCI angina are relevant, and more research seems warranted. The purpose of this document is to review potential mechanisms for the persistence or recurrence of angina post-PCI, propose a practical diagnostic algorithm, and summarize current knowledge gaps.

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“…Полученные данные подтверждают важное прогностическое значение СД 2-го типа, наличие которого является маркером высокого риска развития ИБС [14,16]. Кроме того, в последние годы широко обсуждаются генетические маркеры неблагоприятного жизненного прогноза у лиц без обструкции коронарных сосудов, страдающих стенокардией напряжения и перенесших инфаркт миокарда [17][18][19][20][21][22][23].…”

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Analysis of the effectiveness of selection of women for coronarography in real clinical practice

2019

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Objective: evaluation of the effectiveness of selection for coronary angiography of women who have applied to a cardiologist for thoracalgia and dorsalgia and regarded primarily as having a clinic of stable angina.Materials and methods. 108 women (median age 59.5) applying to cardiologist due to chest pain were included in a cross-sectional study and underwent coronary angiography. Subjects with identified clinically significant atherosclerotic coronary lesions were compared to persons with intact coronary arteries.Results. One-, two- and three-vessel lesions were diagnosed in accordingly 16; 21 and 26 % of patients. Intact coronary arteries were detected in 37 % subjects. In 17 of 40 persons with intact structure of the coronary arteries spasm of the coronary arteries was diagnosed. Odds ratio for atherosclerotic coronary arteries lesions in type 2 diabetic persons were 7.91 (1.74–36.00), for hypertension odds ratio 4.79 (1.52–15.01). Severe angina (3 and 4 functional class) was significantly more often diagnosed in women with identified coronary atherosclerosis. Severe coronary atherosclerosis was associated with absence of negative or doubtful results, whereas intact coronary vessels, negative and questionable results revealed more than half of the women. The obtained data reflect the relevance of the development of more effective algorithms for diagnosis of coronary artery disease in women, since the gender peculiarities of the formation of coronary atherosclerosis have been clearly confirmed in a number of large studies.Conclusion. Medical history, physical load tests results, and subject’s emotional status should be evaluated to assess the feasibility of coronary angiography.

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Determinants of long-term clinical outcomes in patients with angina but without obstructive coronary artery disease: a systematic review and meta-analysis

Cited by 122 publications

References 77 publications

Perimenopause vasomotor symptoms, coronary atherosclerosis and risk of myocardial infarction during menopause: the cardiologist’s perspective

Perimenopause vasomotor symptoms, coronary atherosclerosis and risk of myocardial infarction during menopause: the cardiologist’s perspective

Mechanisms and diagnostic evaluation of persistent or recurrent angina following percutaneous coronary revascularization

Analysis of the effectiveness of selection of women for coronarography in real clinical practice

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