Prognostic Links Between OCT-Delineated Coronary Morphologies and Coronary Functional Abnormalities in Patients With INOCA

Nishimiya, Kensuke; Suda, Akira; Fukui, Kuniaki; Hao, Kun; Takahashi, Jun; Matsumoto, Yasuharu; Mitsuishi, Kiyoto; Watanabe, Tasuku; Ohyama, Kazuma; Sugisawa, Jun; Tsuchiya, Satoshi; Satoh, Koichi; Shindo, Tomohiko; Godo, Shigeo; Kikuchi, Yoku; Shiroto, Takashi; Yasuda, Satoshi; Shimokawa, Hiroaki

doi:10.1016/j.jcin.2020.12.025

Cited by 36 publications

(50 citation statements)

References 36 publications

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“… 30 A recent clinical study assessed the left anterior descending by OCT and functional testing in patients with ischemia and no obstructive CAD and found that density of adventitial vasa vasorum was higher in patients with vasospasm than controls and that patients with focal spasm showed a higher prevalence of advanced atherosclerotic features such as fibroatheroma, macrophages, intraplaque microchannels, and cholesterol crystals. 31 Our findings that macrophages and intraplaque microchannels were frequently observed in vessels with coronary artery spasm are in line with the previous studies. In addition, previous studies have reported that layered plaques are frequently accompanied by macrophages and intraplaque microchannels, as observed in the present study, and associated with rapid plaque progression and higher adverse cardiac events.…”

Section: Discussionsupporting

confidence: 93%

Layered Plaque in Organic Lesions in Patients With Coronary Artery Spasm

Nishi

Kume

Yamada

et al. 2022

JAHA

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Background Coronary artery spasm plays a vital role in the pathogenesis of coronary plaques. We sought to investigate the plaque characteristics of co‐existing organic lesions in patients with coronary artery spasm in comparison to those without coronary artery spasm by intracoronary optical coherence tomography (OCT). Methods and Results We included 39 patients who presented with a symptom suspected of coronary spastic angina and had an organic lesion, defined as ≥plaque burden of 50% assessed by OCT. Coronary artery spasm was diagnosed by positive acetylcholine provocation test, or by spontaneous spasm detected during coronary angiography. A total of 51 vessels with an organic lesion were identified. Of these, coronary artery spasm was observed in 30 vessels (spasm), while not in 21 vessels (non‐spasm). Organic lesions in the spasm vessels, compared with those in the non‐spasm vessels, had a higher prevalence of layered plaque (93% versus 38%, P <0.001), macrophages (80% versus 43%, P =0.016), and intraplaque microchannels (73% versus 24%, P <0.001), and lower prevalence of macrocalcification (23% versus 62%, P =0.009) as assessed by OCT. Conclusions Layered plaque, macrophages, and intraplaque microchannels, were frequently observed in organic lesions in patients with coronary artery spasm. These findings suggest that coronary artery spasm induces local thrombus formation as well as active inflammatory response, therefore increasing the risk of rapid plaque progression and ischemic events in patients with coronary artery spasm.

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Section: Discussionsupporting

confidence: 93%

Layered Plaque in Organic Lesions in Patients With Coronary Artery Spasm

Nishi

Kume

Yamada

et al. 2022

JAHA

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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%

“…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 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].…”

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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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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“…On the contrary, patients with CMD may be predisposed to the development of more vulnerable coronary atherosclerosis and therefore may be prone to future coronary events. 85 …”

Section: Primary Coronary Microcirculatory Dysfunction and Vulnerable Patientsmentioning

confidence: 99%

Endothelium in Coronary Macrovascular and Microvascular Diseases

Godo

Takahashi

Yasuda

et al. 2021

Journal of Cardiovascular Pharmacology

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: The endothelium plays a pivotal role in the regulation of vascular tone by synthesizing and liberating endothelium-derived relaxing factors inclusive of vasodilator prostaglandins (eg, prostacyclin), nitric oxide (NO), and endothelium-dependent hyperpolarization factors in a distinct blood vessel size–dependent manner. Large conduit arteries are predominantly regulated by NO and small resistance arteries by endothelium-dependent hyperpolarization factors. Accumulating evidence over the past few decades has demonstrated that endothelial dysfunction and coronary vasomotion abnormalities play crucial roles in the pathogenesis of various cardiovascular diseases. Structural and functional alterations of the coronary microvasculature have been coined as coronary microvascular dysfunction (CMD), which is highly prevalent and associated with adverse clinical outcomes in many clinical settings. The major mechanisms of coronary vasomotion abnormalities include enhanced coronary vasoconstrictive reactivity at epicardial and microvascular levels, impaired endothelium-dependent and endothelium-independent coronary vasodilator capacities, and elevated coronary microvascular resistance caused by structural factors. Recent experimental and clinical research has highlighted CMD as the systemic small artery disease beyond the heart, emerging modulators of vascular functions, novel insights into the pathogenesis of cardiovascular diseases associated with CMD, and potential therapeutic interventions to CMD with major clinical implications. In this article, we will summarize the current knowledge on the endothelial modulation of vascular tone and the pathogenesis of coronary macrovascular and microvascular diseases from bench to bedside, with a special emphasis placed on the mechanisms and clinical implications of CMD.

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Prognostic Links Between OCT-Delineated Coronary Morphologies and Coronary Functional Abnormalities in Patients With INOCA

Cited by 36 publications

References 36 publications

Layered Plaque in Organic Lesions in Patients With Coronary Artery Spasm

Layered Plaque in Organic Lesions in Patients With Coronary Artery Spasm

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

Endothelium in Coronary Macrovascular and Microvascular Diseases

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