What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Coronary Microvascular Dysfunction (n=6631). Intervention: Coronary Microvascular Dysfunction vs. Patients without CMD. Primary outcome: All-cause mortality (OR 3.93, 95% CI 2.91-5.30, p=<0.001).

What does this research mean for the field?

Coronary Microvascular Dysfunction is associated with a nearly 4-fold increase in all-cause mortality and a 5-fold increase in major adverse cardiac events compared to patients without CMD. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

April 29, 2020Journal of the American Heart AssociationOpen Access

Association of Isolated Coronary Microvascular Dysfunction With Mortality and Major Adverse Cardiac Events: A Systematic Review and Meta‐Analysis of Aggregate Data

Q: What are the key findings of this study?

Coronary Microvascular Dysfunction was associated with a 3.93 times higher risk of all-cause mortality compared to patients without CMD.

Q: What does this research mean for the field?

Coronary Microvascular Dysfunction is associated with a nearly 4-fold increase in all-cause mortality and a 5-fold increase in major adverse cardiac events compared to patients without CMD. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

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Key result

Coronary microvascular dysfunction linked to ~293% higher all-cause mortality risk.

OR 3.93
95% CI 2.91-5.30
P<0.001
n=6,631

Why the study?

The impact of coronary microvascular dysfunction on outcomes in patients with symptoms of myocardial ischemia and nonobstructive coronary artery disease was poorly understood.

Does isolated coronary microvascular dysfunction increase mortality and major adverse cardiac events in patients with symptoms of myocardial ischemia and nonobstructive coronary artery disease?

Population

Patients with symptoms of myocardial ischemia and nonobstructive coronary artery disease

Comparison

Patients with CMD vs patients without CMD

Design

Systematic review and meta-analysis of observational studies

Authors

MGMark GdowskiWashington University in St. Louis VMVenkatesh L. MurthyCardiac Imaging MDMichelle DoeringWashington University in St. Louis

Discussion

Member takes

Implication

CMD may aid risk stratification in nonobstructive CAD; extends observational evidence but leaves causal impact open.

Study Design

Type

Meta-Analysis (n=6,631)

Multicenter

Yes

Structured PICO

Does isolated coronary microvascular dysfunction increase mortality and major adverse cardiac events in patients with symptoms of myocardial ischemia and nonobstructive coronary artery disease?

Population

6,631 patients (for mortality analysis) and 5,189 patients (for MACE analysis) with symptoms of myocardial ischemia and nonobstructive coronary artery disease (type 1 CMD), mean age ranging from 51 to 67 years.

Intervention

Presence of isolated coronary microvascular dysfunction (CMD) diagnosed by abnormally reduced coronary flow reserve (CFR) measured invasively or noninvasively.

Comparator

Absence of coronary microvascular dysfunction (normal coronary flow reserve).

Outcome

All-cause mortality (or cardiac/cardiovascular death if all-cause mortality was not provided).hard clinical

Main Result

Effect estimate: OR 3.93 (95% CI 2.91-5.30)

Absolute Event Rate: 9.3% vs 2.6%

p-value: p=<0.001

Isolated coronary microvascular dysfunction is associated with a nearly 4-fold increase in mortality and a 5-fold increase in major adverse cardiac events in patients with nonobstructive coronary artery disease.

Limitations

CFR is a continuous measure but most studies used dichotomized cutoffs.
Observational study results may be affected by confounding factors.
Included studies were primarily conducted at referral centers.
CFR is a continuous measure but dichotomized using various cutoffs
Based on data from observational studies with potential for unmeasured confounding
Most included studies were performed at referral centers, raising possibility of selection bias
Absence of myocardial ischemia on stress testing used as a surrogate for absence of obstructive CAD in some cases
Inconsistent reporting of medical therapies
Unable to perform sex-specific analysis due to lack of data

Cite This Study

Gdowski et al. (2020) conducted a meta-analysis in Coronary Microvascular Dysfunction (n=6,631). Coronary Microvascular Dysfunction vs. Patients without CMD was evaluated on All-cause mortality (OR 3.93, 95% CI 2.91-5.30, p=<0.001). Coronary Microvascular Dysfunction was associated with a 3.93 times higher risk of all-cause mortality compared to patients without CMD.

synapsesocial.com/papers/696bdcb272d15f53efa1e690 https://doi.org/10.1161/jaha.119.014954

Topics

Coronary artery disease Coronary CT angiography

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Association of Isolated Coronary Microvascular Dysfunction With Mortality and Major Adverse Cardiac Events: A Systematic Review and Meta‐Analysis of Aggregate Data

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Association of Isolated Coronary Microvascular Dysfunction With Mortality and Major Adverse Cardiac Events: A Systematic Review and Meta‐Analysis of Aggregate Data

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

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