Determinants of long-term clinical outcomes in patients with angina but without obstructive coronary artery disease: A systematic review and meta-analysis

Research output: Contribution to journalArticle

Francesco Radico, Marco Zimarino, Fabio Fulgenzi, Fabrizio Ricci, Marta Di Nicola, Lasse Jespersen, Su-Min Chang, Karin H. Humphries, Mario Marzilli, Raffaele De Caterina

Aims The long-term prognosis of angina in patients without obstructive coronary artery disease (CAD) is uncertain. To assess the incidence of long-term adverse outcomes in such patients. Methods and results We searched PubMed, Cochrane Library, the Embase database, and the Clinical Trials Registry for studies published in English until January 2017, assessing the composite primary outcome of all-cause death and non-fatal myocardial infarction using random-effects models to estimate pooled incidences. We identified 54 studies, reporting outcomes in overall 35 039 patients (mean age 56, male/female ratio 0.51, 99 770 person-years) with angina and no obstructive CAD. After a median follow-up of 5 years (interquartile range 3-7 years), the pooled incidence of the primary outcome was 0.98/100 person-years [95% confidence interval (CI) 0.77-1.19%], with considerable heterogeneity among studies (I 2 = 91%, P < 0.001). The primary outcome was associated with prevalent dyslipidaemia (P = 0.016), diabetes (P = 0.035), and hypertension (P = 0.016). Studies enrolling patients with less-than-obstructive CAD showed a higher incidence of the primary outcome (1.32/100 person-years, 95% CI 1.02-1.62) compared with studies including only patients with 'entirely normal' coronary arteries (0.52/100 person-years, 95% CI 0.34-0.79, respectively; P < 0.01). The incidence of the primary outcome did not differ significantly between studies enrolling only patients with documented myocardial ischaemia and those studies enrolling patients regardless of presence of ischaemia. However, ischaemia documented by non-invasive imaging techniques was associated with a higher incidence of events (P = 0.02). Overall, these patients, however, suffered from a high incidence of recurrent hospitalization. Conclusion Angina without obstructive CAD has a heterogeneous prognosis. A main determinant of major adverse events is the presence of 'some' coronary atherosclerosis, with unequivocal myocardial ischaemia being associated with worse clinical outcomes. Patients' quality of life is also worsened by the high incidence of hospitalization, angina recurrence, and repeated coronary angiography.

Original languageEnglish (US)
Pages (from-to)2135-2146
Number of pages12
JournalEuropean Heart Journal
Volume39
Issue number23
DOIs
StatePublished - Jun 14 2018

PMID: 29688324

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Determinants of long-term clinical outcomes in patients with angina but without obstructive coronary artery disease : A systematic review and meta-analysis. / Radico, Francesco; Zimarino, Marco; Fulgenzi, Fabio; Ricci, Fabrizio; Di Nicola, Marta; Jespersen, Lasse; Chang, Su-Min; Humphries, Karin H.; Marzilli, Mario; De Caterina, Raffaele.

In: European Heart Journal, Vol. 39, No. 23, 14.06.2018, p. 2135-2146.

Research output: Contribution to journalArticle

Harvard

Radico, F, Zimarino, M, Fulgenzi, F, Ricci, F, Di Nicola, M, Jespersen, L, Chang, S-M, Humphries, KH, Marzilli, M & De Caterina, R 2018, 'Determinants of long-term clinical outcomes in patients with angina but without obstructive coronary artery disease: A systematic review and meta-analysis' European Heart Journal, vol. 39, no. 23, pp. 2135-2146. https://doi.org/10.1093/eurheartj/ehy185

APA

Radico, F., Zimarino, M., Fulgenzi, F., Ricci, F., Di Nicola, M., Jespersen, L., ... De Caterina, R. (2018). Determinants of long-term clinical outcomes in patients with angina but without obstructive coronary artery disease: A systematic review and meta-analysis. European Heart Journal, 39(23), 2135-2146. https://doi.org/10.1093/eurheartj/ehy185

Vancouver

Radico F, Zimarino M, Fulgenzi F, Ricci F, Di Nicola M, Jespersen L et al. Determinants of long-term clinical outcomes in patients with angina but without obstructive coronary artery disease: A systematic review and meta-analysis. European Heart Journal. 2018 Jun 14;39(23):2135-2146. https://doi.org/10.1093/eurheartj/ehy185

Author

Radico, Francesco ; Zimarino, Marco ; Fulgenzi, Fabio ; Ricci, Fabrizio ; Di Nicola, Marta ; Jespersen, Lasse ; Chang, Su-Min ; Humphries, Karin H. ; Marzilli, Mario ; De Caterina, Raffaele. / Determinants of long-term clinical outcomes in patients with angina but without obstructive coronary artery disease : A systematic review and meta-analysis. In: European Heart Journal. 2018 ; Vol. 39, No. 23. pp. 2135-2146.

BibTeX

@article{ac9f150da29f454ebcbd219bde48b882,
title = "Determinants of long-term clinical outcomes in patients with angina but without obstructive coronary artery disease: A systematic review and meta-analysis",
abstract = "Aims The long-term prognosis of angina in patients without obstructive coronary artery disease (CAD) is uncertain. To assess the incidence of long-term adverse outcomes in such patients. Methods and results We searched PubMed, Cochrane Library, the Embase database, and the Clinical Trials Registry for studies published in English until January 2017, assessing the composite primary outcome of all-cause death and non-fatal myocardial infarction using random-effects models to estimate pooled incidences. We identified 54 studies, reporting outcomes in overall 35 039 patients (mean age 56, male/female ratio 0.51, 99 770 person-years) with angina and no obstructive CAD. After a median follow-up of 5 years (interquartile range 3-7 years), the pooled incidence of the primary outcome was 0.98/100 person-years [95{\%} confidence interval (CI) 0.77-1.19{\%}], with considerable heterogeneity among studies (I 2 = 91{\%}, P < 0.001). The primary outcome was associated with prevalent dyslipidaemia (P = 0.016), diabetes (P = 0.035), and hypertension (P = 0.016). Studies enrolling patients with less-than-obstructive CAD showed a higher incidence of the primary outcome (1.32/100 person-years, 95{\%} CI 1.02-1.62) compared with studies including only patients with 'entirely normal' coronary arteries (0.52/100 person-years, 95{\%} CI 0.34-0.79, respectively; P < 0.01). The incidence of the primary outcome did not differ significantly between studies enrolling only patients with documented myocardial ischaemia and those studies enrolling patients regardless of presence of ischaemia. However, ischaemia documented by non-invasive imaging techniques was associated with a higher incidence of events (P = 0.02). Overall, these patients, however, suffered from a high incidence of recurrent hospitalization. Conclusion Angina without obstructive CAD has a heterogeneous prognosis. A main determinant of major adverse events is the presence of 'some' coronary atherosclerosis, with unequivocal myocardial ischaemia being associated with worse clinical outcomes. Patients' quality of life is also worsened by the high incidence of hospitalization, angina recurrence, and repeated coronary angiography.",
keywords = "Angina, Coronary atherosclerosis, Myocardial ischaemia, Non-obstructive coronary artery disease, Normal coronary arteries",
author = "Francesco Radico and Marco Zimarino and Fabio Fulgenzi and Fabrizio Ricci and {Di Nicola}, Marta and Lasse Jespersen and Su-Min Chang and Humphries, {Karin H.} and Mario Marzilli and {De Caterina}, Raffaele",
year = "2018",
month = "6",
day = "14",
doi = "10.1093/eurheartj/ehy185",
language = "English (US)",
volume = "39",
pages = "2135--2146",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "23",

}

RIS

TY - JOUR

T1 - Determinants of long-term clinical outcomes in patients with angina but without obstructive coronary artery disease

T2 - European Heart Journal

AU - Radico, Francesco

AU - Zimarino, Marco

AU - Fulgenzi, Fabio

AU - Ricci, Fabrizio

AU - Di Nicola, Marta

AU - Jespersen, Lasse

AU - Chang, Su-Min

AU - Humphries, Karin H.

AU - Marzilli, Mario

AU - De Caterina, Raffaele

PY - 2018/6/14

Y1 - 2018/6/14

N2 - Aims The long-term prognosis of angina in patients without obstructive coronary artery disease (CAD) is uncertain. To assess the incidence of long-term adverse outcomes in such patients. Methods and results We searched PubMed, Cochrane Library, the Embase database, and the Clinical Trials Registry for studies published in English until January 2017, assessing the composite primary outcome of all-cause death and non-fatal myocardial infarction using random-effects models to estimate pooled incidences. We identified 54 studies, reporting outcomes in overall 35 039 patients (mean age 56, male/female ratio 0.51, 99 770 person-years) with angina and no obstructive CAD. After a median follow-up of 5 years (interquartile range 3-7 years), the pooled incidence of the primary outcome was 0.98/100 person-years [95% confidence interval (CI) 0.77-1.19%], with considerable heterogeneity among studies (I 2 = 91%, P < 0.001). The primary outcome was associated with prevalent dyslipidaemia (P = 0.016), diabetes (P = 0.035), and hypertension (P = 0.016). Studies enrolling patients with less-than-obstructive CAD showed a higher incidence of the primary outcome (1.32/100 person-years, 95% CI 1.02-1.62) compared with studies including only patients with 'entirely normal' coronary arteries (0.52/100 person-years, 95% CI 0.34-0.79, respectively; P < 0.01). The incidence of the primary outcome did not differ significantly between studies enrolling only patients with documented myocardial ischaemia and those studies enrolling patients regardless of presence of ischaemia. However, ischaemia documented by non-invasive imaging techniques was associated with a higher incidence of events (P = 0.02). Overall, these patients, however, suffered from a high incidence of recurrent hospitalization. Conclusion Angina without obstructive CAD has a heterogeneous prognosis. A main determinant of major adverse events is the presence of 'some' coronary atherosclerosis, with unequivocal myocardial ischaemia being associated with worse clinical outcomes. Patients' quality of life is also worsened by the high incidence of hospitalization, angina recurrence, and repeated coronary angiography.

AB - Aims The long-term prognosis of angina in patients without obstructive coronary artery disease (CAD) is uncertain. To assess the incidence of long-term adverse outcomes in such patients. Methods and results We searched PubMed, Cochrane Library, the Embase database, and the Clinical Trials Registry for studies published in English until January 2017, assessing the composite primary outcome of all-cause death and non-fatal myocardial infarction using random-effects models to estimate pooled incidences. We identified 54 studies, reporting outcomes in overall 35 039 patients (mean age 56, male/female ratio 0.51, 99 770 person-years) with angina and no obstructive CAD. After a median follow-up of 5 years (interquartile range 3-7 years), the pooled incidence of the primary outcome was 0.98/100 person-years [95% confidence interval (CI) 0.77-1.19%], with considerable heterogeneity among studies (I 2 = 91%, P < 0.001). The primary outcome was associated with prevalent dyslipidaemia (P = 0.016), diabetes (P = 0.035), and hypertension (P = 0.016). Studies enrolling patients with less-than-obstructive CAD showed a higher incidence of the primary outcome (1.32/100 person-years, 95% CI 1.02-1.62) compared with studies including only patients with 'entirely normal' coronary arteries (0.52/100 person-years, 95% CI 0.34-0.79, respectively; P < 0.01). The incidence of the primary outcome did not differ significantly between studies enrolling only patients with documented myocardial ischaemia and those studies enrolling patients regardless of presence of ischaemia. However, ischaemia documented by non-invasive imaging techniques was associated with a higher incidence of events (P = 0.02). Overall, these patients, however, suffered from a high incidence of recurrent hospitalization. Conclusion Angina without obstructive CAD has a heterogeneous prognosis. A main determinant of major adverse events is the presence of 'some' coronary atherosclerosis, with unequivocal myocardial ischaemia being associated with worse clinical outcomes. Patients' quality of life is also worsened by the high incidence of hospitalization, angina recurrence, and repeated coronary angiography.

KW - Angina

KW - Coronary atherosclerosis

KW - Myocardial ischaemia

KW - Non-obstructive coronary artery disease

KW - Normal coronary arteries

UR - http://www.scopus.com/inward/record.url?scp=85048759701&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85048759701&partnerID=8YFLogxK

U2 - 10.1093/eurheartj/ehy185

DO - 10.1093/eurheartj/ehy185

M3 - Article

VL - 39

SP - 2135

EP - 2146

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 23

ER -

ID: 40014525