Functional and Economic Impact of INOCA and Influence of Coronary Microvascular Dysfunction

Schumann, Christopher; Mathew, Roshin C.; Dean, John-Henry L; Yang, Ya; Balfour, Pelbreton C.; Shaw, P.W.; Robinson, Austin A.; Salerno, Michael; Kramer, Christopher M.; Bourque, Jamieson M.

doi:10.1016/j.jcmg.2021.01.041

Cited by 64 publications

(33 citation statements)

References 38 publications

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“…nonobstructive CAD varies substantially depending on their underlying causes [6][7][8][9]. Overall, increasing evidence reveals that the presence of nonobstructive CAD contributes to higher risks of mortality [10][11][12], myocardial infarction (MI) [11,12], re-hospitalization for angina [12], and economic burden [13].…”

Section: Discussionmentioning

confidence: 99%

“…A personalized antiplatelet regimen might contribute to reduction in ischemic cardiovascular events in patients with nonobstructive CAD.Registration: PROSPERO (CRD42021281706).nonobstructive CAD varies substantially depending on their underlying causes [6][7][8][9]. Overall, increasing evidence reveals that the presence of nonobstructive CAD contributes to higher risks of mortality [10][11][12], myocardial infarction (MI) [11,12], re-hospitalization for angina [12], and economic burden [13].Currently, the detection of nonobstructive CAD increases the prescription of cardiovascular preventive medical therapies, including aspirin [14][15][16][17]. Aspirin, a cornerstone agent, signi cantly reduces the risk of ischemic events in patients with obstructive CAD [18].…”

mentioning

confidence: 99%

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Association of Aspirin Therapy with Prognosis in Patients with Nonobstructive Coronary Artery Disease: A Systematic Review and Meta-Analysis

Fan

Mao

Zhou

et al. 2022

Preprint

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PurposeThe effect of aspirin therapy in patients with nonobstructive coronary artery disease (CAD) remains controversial. This study aimed to investigate the association between aspirin therapy and prognosis in nonobstructive CAD.MethodsWe searched for observational cohort studies on Pubmed, Embase, the Cochrane Library and Web of Science. Studies were included that compared the endpoint differences in patients with nonobstructive CAD who were treated with aspirin or not. The primary endpoint was a composite of major adverse cardiovascular events (MACEs). Secondary endpoints included all-cause death, cardiovascular death and myocardial infarction (MI). The pooled effect size was estimated as hazard ratio (HR) with 95% confidence interval (CI), which was measured by a random effect model using the generic inverse variance method.ResultsThirteen published studies with 34,463 patients were included. Pooled data showed that aspirin therapy was not associated with the risk of MACEs (HR 1.10; 95% CI 0.85–1.41; P = 0.47, I2 = 57%). Similar results were observed in cardiovascular death (HR 1.12; 95% CI 0.73–1.73; P = 0.60, I2 = 0%) and MI (HR 0.53; 95% CI 0.09–3.20; P = 0.49, I2 = 68%), except all-cause death (HR 0.77; 95% CI 0.63–0.95; P = 0.02, I2 = 25%). Subgroup analyses showed that there were no associations between aspirin therapy and MACEs in all subsets.ConclusionsRoutine aspirin therapy might not improve prognosis in patients with nonobstructive CAD. Aspirin therapy in non-obstructive CAD should be better investigated and future research is needed. A personalized antiplatelet regimen might contribute to reduction in ischemic cardiovascular events in patients with non-obstructive CAD.Registration: PROSPERO (CRD42021281706).

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Association of Aspirin Therapy with Prognosis in Patients with Nonobstructive Coronary Artery Disease: A Systematic Review and Meta-Analysis

Fan

Mao

Zhou

et al. 2022

Preprint

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“…This cost to the individual and to society from such loses has been shown to be significant (21) J o u r n a l P r e -p r o o f…”

Section: Discussionmentioning

confidence: 99%

Stratified medicine using invasive coronary function testing in angina: A cost-effectiveness analysis of the British Heart Foundation CorMicA trial

Heggie¹,

Briggs

Stanley

et al. 2021

International Journal of Cardiology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…The economic burden of CMVD is substantial, with patients reporting poor quality of life and productivity factors such as limitations in total productivity and increased worker absenteeism. This burden has been estimated to nearly $14,000 per patient annually [9]. In this review, we aim to provide insight into the background of CMVD, diagnostic imaging modalities, and management.…”

Section: Introductionmentioning

confidence: 99%

Coronary Microvascular Disease

Thakker

Lozano

et al. 2022

Cardiol Ther

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Coronary microvascular disease or dysfunction (CMVD) has been associated with adverse cardiovascular outcomes. Despite a growing prevalence, guidelines on definitive treatment are lacking. Proposed mechanisms of endothelial dysfunction and resultant inflammation have been demonstrated as the underlying cause. Imaging modalities such as echocardiography, cardiac MRI, PET, and in some instances CT, have been shown to be useful in diagnosing CMVD mainly through assessment of coronary blood flow. Invasive measurements through thermodilution and pressure sensor-guided Doppler microcatheters have also been utilized. Treatment options are directed at targeting inflammatory pathways and angina. In our review, we highlight the current literature on the background of CMVD, diagnostic modalities, and management of this disease.

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Functional and Economic Impact of INOCA and Influence of Coronary Microvascular Dysfunction

Cited by 64 publications

References 38 publications

Association of Aspirin Therapy with Prognosis in Patients with Nonobstructive Coronary Artery Disease: A Systematic Review and Meta-Analysis

Association of Aspirin Therapy with Prognosis in Patients with Nonobstructive Coronary Artery Disease: A Systematic Review and Meta-Analysis

Stratified medicine using invasive coronary function testing in angina: A cost-effectiveness analysis of the British Heart Foundation CorMicA trial

Coronary Microvascular Disease

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