Long-term outcomes of ischaemia with no obstructive coronary artery disease (INOCA): a systematic review and meta-analysis.

IF 2.8 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Open Heart Pub Date : 2024-10-01 DOI:10.1136/openhrt-2024-002852

Natalija Odanović, Alexandra N Schwann, Zhiyuan Zhang, Sohum S Kapadia, Steffne J Kunnirickal, Helen Parise, Daniela Tirziu, Ivan Ilic, Alexandra J Lansky, Cody G Pietras, Samit M Shah

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Abstract

Background: The prognosis of myocardial ischaemia with no obstructive coronary artery disease (INOCA) and its underlying vasomotor disorders, vasospastic angina (VSA) and microvascular angina (MVA), is not well defined. The aim of this study was to perform a systematic review and meta-analysis of studies evaluating the long-term prognosis of patients with INOCA.

Methods: We included studies evaluating the prognosis of patients with INOCA published between January 1984 and August 2023 in Medline, Embase, Web of Science and Cochrane databases. Studies were selected if they included patients who fulfilled the Coronary Vasomotor Disorders International Study Group (COVADIS) criteria for either possible or definitive VSA or MVA. The primary outcomes were composite of all-cause death and myocardial infarction (MI), and major adverse cardiovascular event (MACE) at annual intervals up to 5-year follow-up. The incidence of primary outcomes for INOCA, each INOCA endotype and by method used to determine the diagnosis was calculated using the random effects model.

Results: Fifty-four studies (17 302 patients) meeting the eligibility criteria were selected. The rate of all-cause death and MI with VSA was 0.7 (95% CI 0.4 to 1.0)/100 patient-years and with MVA was 1.1 (95% CI 0.7 to 1.5)/100 patient-years (p>0.05). The rate of MACE with VSA was 1.1 (95% CI 0.5 to 1.9)/100 patient-years and with MVA was 2.5 (95% CI 1.6 to 3.6)/100 patient-years (p=0.025). Patients with reduced coronary flow reserve (CFR) had higher all-cause death and MI rates than patients whose diagnosis of MVA was established based on an abnormal exercise or imaging stress test (4.7 (95% CI 2.0 to 8.4) vs 0.5 (95% CI 0.1 to 1.1) vs 1.1 (95% CI 0.5 to 2.0)/100 patient-years, p=0.001).

Conclusions: Overall, patients with INOCA have a low rate of MACEs, but patients with MVA, especially those with reduced CFR, have a significantly higher rate of MACE than other subgroups, although there is high heterogeneity among the included studies.

Prospero registration number: CRD42021275070.

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无阻塞性冠状动脉疾病（INOCA）缺血的长期疗效：系统回顾和荟萃分析。

背景：无梗阻性冠状动脉疾病（INOCA）心肌缺血及其潜在的血管运动障碍--血管痉挛性心绞痛（VSA）和微血管性心绞痛（MVA）的预后尚不明确。本研究旨在对评估 INOCA 患者长期预后的研究进行系统回顾和荟萃分析：我们在 Medline、Embase、Web of Science 和 Cochrane 数据库中纳入了 1984 年 1 月至 2023 年 8 月间发表的评估 INOCA 患者预后的研究。如果研究中的患者符合冠状动脉血管运动障碍国际研究组（COVADIS）的可能或明确VSA或MVA标准，则入选。主要结果是全因死亡和心肌梗死（MI）的复合结果，以及随访5年的主要不良心血管事件（MACE）。采用随机效应模型计算了INOCA、每种INOCA终末型和用于确定诊断的方法的主要结局发生率：结果：54项研究（17 302名患者）符合资格标准。VSA的全因死亡和心肌梗死发生率为0.7（95% CI 0.4至1.0）/100例患者年，MVA的全因死亡和心肌梗死发生率为1.1（95% CI 0.7至1.5）/100例患者年（P>0.05）。VSA患者的MACE发生率为1.1（95% CI 0.5至1.9）/100患者年，MVA患者的MACE发生率为2.5（95% CI 1.6至3.6）/100患者年（P=0.025）。冠状动脉血流储备（CFR）降低的患者的全因死亡率和心肌梗死率高于根据运动或造影压力测试异常确诊为MVA的患者（4.7（95% CI 2.0至8.4） vs 0.5（95% CI 0.1至1.1） vs 1.1（95% CI 0.5至2.0）/100患者年，P=0.001）：总体而言，INOCA患者的MACE发生率较低，但MVA患者，尤其是CFR降低的患者的MACE发生率明显高于其他亚组，尽管纳入的研究之间存在高度异质性：CRD42021275070。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Open Heart CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.60

自引率

3.70%

发文量

145

审稿时长

20 weeks

期刊介绍： Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.