Nonobstructive Versus Obstructive Coronary Artery Disease in Acute Coronary Syndrome: A Meta‐Analysis

Abstract

BackgroundDifferences in prognosis and baseline clinical presentation have been documented among patient with acute coronary syndrome and coronary artery disease with obstructive (ObCAD) or nonobstructive arteries (NObCAD), but the rates of events largely varied across single studies. We carried out a meta‐analysis to compare the clinical presentation and prognosis of NObCAD versus ObCAD acute coronary syndrome patients, as well as of the subjects with zero versus mild occlusion.Methods and ResultsSearches were made in MedLine, EMBASE, Cochrane databases, and proceedings of international meetings up to June 30, 2015. We compared the risk of events of NObCAD versus ObCAD patients using random‐effect meta‐analyses. We also performed meta‐analyses to estimate the yearly or monthly outcome rates in each single group. In NObCAD and ObCAD patients, respectively, the combined yearly rates were as follows: 2.4% versus 10.1% (all‐cause mortality); 1.2% versus 6.0% (myocardial infarction), 4.0% versus 12.8% (all‐cause mortality plus myocardial infarction), 1.4% versus 5.9% (cardiac death), and 9.2% versus 16.8% (major cardiovascular events). In the studies directly comparing NObCAD versus ObCAD, all of the above outcomes were significantly less frequent in NObCAD subjects (with risk ratios ranging from 0.33 to 0.66). No differences in any outcome rate were observed between mild occlusion (1–49% stenosis) and zero occlusion patients.Conclusions NObCAD in patients with acute coronary syndrome has a significantly lower cardiovascular risk at baseline and a subsequent lower likelihood of death or main cardiovascular events. However, these subjects are still at high risk for cardiovascular mortality and morbidity, suggesting potential undertreatment and calling for specific management.

Secondary Prevention Medical Therapy and Outcomes in Patients With Myocardial Infarction With Non-Obstructive Coronary Artery Disease

“…Literature prognosis data showed that MINOCA is not a benign condition, with an overall estimated mortality around 3.5-4.5% (Pasupathy et al, 2015;Baron et al, 2016;Pizzi et al, 2016;Barr et al, 2018). This unfavorable outcome might be explained, at least in part, by the low rate of b-blockers, angiotensin converting enzyme inhibitors (ACEI), statins, and antiplatelet drugs prescription.…”

The LDL-C/HDL-C ratio and 4-year risk of coronary artery disease: a retrospective study

“…Large retrospective studies of patients referred for nonurgent angiography demonstrated a prevalence of non-obstructive CAD of between 20% and 60% of all referrals. Furthermore, while classically non-obstructive CAD had not been thought to be associated with increased risk of mortality or cardiovascular events, more recent evidence suggests that certain subpopulations with non-obstructive CAD are at heightened risk [26,[32][33][34][35]. In our study, CAD was quantitatively defined as a diameter stenosis ≥ 50% in a major epicardial artery.…”

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“…Samkvaemt rannsóknum eru MINOCAsjúklingar ólíklegri en sjúklingar með marktaekar þrengingar til þess að vera meðhöndlaðir með viðeigandi lyfjameðferð samkvaemt klínískum leiðbeiningum um meðferð á sjúklingum með kransaeðasjúkdóma. 18,19 Nýlega kom út rannsókn frá Svíþjóð sem veitti í fyrsta skipti innsýn inn í árangur af langtíma lyfjameðferð MINOCA-sjúklinga. Þetta var áhorfsrannsókn (observational study) þar sem 9466 sjúklingum var fylgt eftir og var markmiðið að kanna tengsl meðferðar með einstökum lyfjaflokkum við alvarlega hjartatengda atburði (major cardiac adverse event) við eftirfylgni.…”