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Mileva N, Nagumo S, Mizukami T, Sonck J, Berry C, Gallinoro E, Monizzi G, Candreva A, Munhoz D, Vassilev D, Penicka M, Barbato E, De Bruyne B, Collet C. Prevalence of Coronary Microvascular Disease and Coronary Vasospasm in Patients With Nonobstructive Coronary Artery Disease: Systematic Review and Meta-Analysis. J Am Heart Assoc 2022; 11:e023207. [PMID: 35301851 PMCID: PMC9075440 DOI: 10.1161/jaha.121.023207] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background A relevant proportion of patients with suspected coronary artery disease undergo invasive coronary angiography showing normal or nonobstructive coronary arteries. However, the prevalence of coronary microvascular disease (CMD) and coronary spasm in patients with nonobstructive coronary artery disease remains to be determined. The objective of this study was to determine the prevalence of coronary CMD and coronary vasospastic angina in patients with no obstructive coronary artery disease. Methods and Results A systematic review and meta‐analysis of studies assessing the prevalence of CMD and vasospastic angina in patients with no obstructive coronary artery disease was performed. Random‐effects models were used to determine the prevalence of these 2 disease entities. Fifty‐six studies comprising 14 427 patients were included. The pooled prevalence of CMD was 0.41 (95% CI, 0.36–0.47), epicardial vasospasm 0.40 (95% CI, 0.34–0.46) and microvascular spasm 24% (95% CI, 0.21–0.28). The prevalence of combined CMD and vasospastic angina was 0.23 (95% CI, 0.17–0.31). Female patients had a higher risk of presenting with CMD compared with male patients (risk ratio, 1.45 [95% CI, 1.11–1.90]). CMD prevalence was similar when assessed using noninvasive or invasive diagnostic methods. Conclusions In patients with no obstructive coronary artery disease, approximately half of the cases were reported to have CMD and/or coronary spasm. CMD was more prevalent among female patients. Greater awareness among physicians of ischemia with no obstructive coronary arteries is urgently needed for accurate diagnosis and patient‐tailored management.
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Affiliation(s)
- Niya Mileva
- Cardiovascular Center Aalst OLV Hospital Aalst Belgium.,Cardiology Clinic Alexandrovska University Hospital Sofia Bulgaria
| | - Sakura Nagumo
- Cardiovascular Center Aalst OLV Hospital Aalst Belgium.,Division of Cardiology Department of Internal Medicine Showa UniversityFujigaoka Hospital Kanagawa Japan
| | - Takuya Mizukami
- Division of Cardiology Department of Internal Medicine Showa UniversityFujigaoka Hospital Kanagawa Japan
| | - Jeroen Sonck
- Cardiovascular Center Aalst OLV Hospital Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples, Federico II Naples Italy
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow United Kingdom
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst OLV Hospital Aalst Belgium.,Department of Translational Medical Sciences University of Campania "Luigi Vanvitelli" Naples Italy
| | | | | | - Daniel Munhoz
- Cardiovascular Center Aalst OLV Hospital Aalst Belgium.,Department of Clinical Medicine Discipline of Cardiology University of Campinas UNICAMP Campinas Brazil.,Department of Advanced Biomedical Sciences University of Naples, Federico II Naples Italy
| | - Dobrin Vassilev
- Cardiology Clinic Alexandrovska University Hospital Sofia Bulgaria
| | | | - Emanuele Barbato
- Cardiovascular Center Aalst OLV Hospital Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples, Federico II Naples Italy
| | - Bernard De Bruyne
- Cardiovascular Center Aalst OLV Hospital Aalst Belgium.,Department of Cardiology Lausanne University Hospital Lausanne Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst OLV Hospital Aalst Belgium
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Radico F, Di Castelnuovo A, Aimo A, Zimarino M, Knuuti J, Rossi S, Pastormerlo LE, Zyw L, Orsini E, Iacoviello L, Neglia D, Emdin M, de Gaetano G, De Caterina R. Factors for heterogeneous outcomes of angina and myocardial ischemia without obstructive coronary atherosclerosis. J Intern Med 2022; 291:197-206. [PMID: 34487597 DOI: 10.1111/joim.13390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES The absence of obstructive coronary artery disease (CAD) in patients with angina is common, but its prognosis is debated. We investigated outcomes of such patients to identify predictors of cardiovascular events. METHODS We selected 1014 patients with angina, evidence of myocardial ischemia at the electrocardiogram (ECG) exercise test or imaging stress tests, and nonobstructive CAD (absence of lumen diameter reduction ≥50%) at coronary angiography between 1999 and 2015. Note that, 1905 age- and risk factors-matched asymptomatic subjects served as "real-world" comparators. The primary endpoint was the occurrence of all-cause death or myocardial infarction. RESULTS At 6-years median follow-up (interquartile range, 3-9 years), the primary endpoint occurred in 53 patients (5.5%, 0.92/100 person-years). Besides similar event rates compared with asymptomatic subjects (hazard ratio [HR] 0.85, 95% confidence interval [CI] 0.62-1.15, p = 0.28), the index population showed a very heterogeneous prognosis. Patients with nonobstructive CAD (HR 1.85, 95% CI 1.02-3.37, p = 0.04, compared with "normal" coronary arteries) and ischemia at imaging tests (HR 2.11, 95% CI 1.07-4.14, p = 0.03, compared with ischemia detected only at the ECG exercise test) were at higher risk and those with both these components showing even >10-fold event rates as compared with the absence of both. Three-hundred and twenty-five patients (34%) continued to experience angina, 69 (7.2%) underwent repeat coronary angiography, and 14 (1.5%) had consequent coronary revascularization for atherosclerosis progression. CONCLUSION Apart from the impaired quality of life, angina without obstructive CAD has an overall benign but very heterogeneous prognosis. Nonobstructive CAD and myocardial ischemia at imaging tests both confer a higher risk.
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Affiliation(s)
- Francesco Radico
- Institute of Cardiology, "G. d'Annunzio" University, Chieti, Italy.,ASL 2 Abruzzo, Chieti, Italy
| | | | - Alberto Aimo
- Scuola Superiore Sant'Anna, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Marco Zimarino
- Institute of Cardiology, "G. d'Annunzio" University, Chieti, Italy.,Interventional Cath Lab, Chieti, Italy
| | - Juhani Knuuti
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Serena Rossi
- Institute of Cardiology, "G. d'Annunzio" University, Chieti, Italy.,Interventional Cath Lab, Chieti, Italy
| | | | - Luc Zyw
- Scuola Superiore Sant'Anna, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Enrico Orsini
- Cardiovascular Division, Pisa University Hospital, and University of Pisa, Via Paradisa, 2, Pisa, 56124, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed Mediterranean Neurological Institute, Pozzilli, Italy.,Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy
| | - Danilo Neglia
- Scuola Superiore Sant'Anna, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Michele Emdin
- Scuola Superiore Sant'Anna, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS Neuromed Mediterranean Neurological Institute, Pozzilli, Italy
| | - Raffaele De Caterina
- Cardiovascular Division, Pisa University Hospital, and University of Pisa, Via Paradisa, 2, Pisa, 56124, Italy.,Fondazione Villa Serena per la Ricerca, Città Sant'Angelo, Italy
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3
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Alqarni MS, Bukhari ZM, Abukhodair AW, Binammar DY, Alzahrani A, Alkahtani A, Albugami S. Diagnostic Value of Single-Photon Emission Tomography Stress Test in Patients With Suspected Coronary Artery Disease in Saudi Arabia. Cureus 2021; 13:e19071. [PMID: 34824946 PMCID: PMC8610429 DOI: 10.7759/cureus.19071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 12/02/2022] Open
Abstract
Background Invasive coronary angiography (ICA) is the gold standard procedure for the diagnosis of coronary artery disease (CAD). ICA allows for clear visualization of the coronary arterial blood flow. Single-photon emission computed tomography (SPECT) is currently in widespread use to non-invasively evaluate patients known or suspected of coronary artery disease (CAD). This study aimed to examine the association between (SPECT) stress test and elective ICA in terms of diagnostic value in patients suspected of coronary artery disease at the King Faisal Cardiac Center (KFCC), Jeddah, Saudi Arabia. Methods This study is a retrospective diagnostic validation study using a consecutive sampling technique to select the study sample at KFCC. The study included all patients who presented with chest pain that were investigated with either exercise or pharmacologic myocardial perfusion SPECT study followed by elective ICA within six months from January 2015 to January 2020. Results A total of 207 patients met the inclusion criteria, where 43% (n = 90) of patients were females and 57% (n = 117) were males; 68% (n = 141) of the patients had both test results concordant (both SPECT and ICA results were in agreement). In 32% of the patients (n = 66), there was a discordant result (discrepant result between SPECT and ICA). SPECT had a sensitivity of 92.4% and a specificity of 26.3%. SPECT had a negative predictive value of 0.68 and a positive predictive value of 0.66 compared to ICA. There was a low degree of reliability between SPECT and ICA. Conclusion Reliability between the SPECT and ICA in exclusion of significant CAD is high. The rate of false-positive tests was high while the accuracy of SPECT in detecting CAD in patients with diabetes and hypertension was high. The overall reliability of SPECT to ICA in the Saudi population was low.
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Affiliation(s)
- Mohammed S Alqarni
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.,Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Ziad M Bukhari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.,Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Abdulkarim W Abukhodair
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.,Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Dina Y Binammar
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.,Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Atif Alzahrani
- Cardiac Sciences, Ministry of National Guard Health Affairs, Jeddah, SAU
| | - Abdulkareem Alkahtani
- Medical Imaging, Ministry of National Guard Health Affairs, Jeddah, SAU.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Saad Albugami
- Cardiology, King Faisal Cardiac Center, King Abdulaziz Medical City, Jeddah, SAU.,Cardiology, King Abdullah International Medical Research Center, Jeddah, SAU.,Cardiology, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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