ANMCO POSITION PAPER: Prognostic and therapeutic relevance of non-obstructive coronary atherosclerosis

Figures

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  Figure 1. Even-free survival and age adjusted survival of 4711 women and 6512 men who performed an invasive coronary angiography for stable angina categorized according to the presence and severity of atherosclerosis. Obstructive coronary artery disease was defined as the presence of at least one stenosis >50%. Non-obstructive coronary artery disease was defined as the presence of 1-49% lesion of at least one epicardial artery. The observed events included cardiovascular death, hospitalization for myocardial infarction, heart failure and stroke. It can be noted how non-obstructive coronary atherosclerosis (NobsCAD) has a negative prognostic value, comparable to that observed for patients with a critical stenosis in men while it is even higher for women. (NobsCAD = non-obstructive coronary artery disease, OCD = Obstructive coronary disease, 1-2-3V = 1-2-3 vessels (Adapted from Jespersen et al.).32

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  Figure 2. Survival probability of patients with obstructive coronary disease (OCD), non-obstructice coronary artery disease (NobsCAD) and with no atherosclerotic disease (NO-CAD). NobsCAD is further categorized based on the number of vessels diseased. The progressive burden of NobsCAD is associated with an increasingly worse outcome. 3VNobsCAD carries a worse outcome compared to OCD. Adapted from Min et al.5 and Lin et al.6

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  Figure 3. Summary of recommendations guided by the presence or absence of signs of coronary atherosclerosis. When there is no coronary atherosclerosis (a) the therapeutic choices are guided by the global cardiovascular risk of the patient. When atherosclerosis is detected the choice of treatment should be directed to halt the progression of disease and prevent acute events either for non-obstructive (b) or obstructive (c) disease. If only a NobsCAD is found (b) a preventive therapy should be started and personalized based upon both the clinical presentation and the severity of the atherosclerotic burden. When an obstructive disease is found (c) patients should receive a similar therapeutic approach to those with NobsCAD and eventually undergo a percutaneous interventional therapy if indicated.