Key result
Therapy with ACEIs and ARBs significantly improved coronary flow reserve compared to baseline (SMD 1.12) in patients without obstructive coronary artery disease.
Why the study?
The impact of cardiovascular medications on coronary flow reserve in patients without obstructive coronary artery disease needed investigation.
Does oral drug therapy improve coronary flow reserve in patients without significant stenosis of epicardial coronary arteries?
Meta-Analysis (n=845)
Does oral drug therapy improve coronary flow reserve in patients without significant stenosis of epicardial coronary arteries?
Standardized Mean Difference: 1.12 (95% CI 0.77–1.47)
Oral therapy with ACEIs, ARBs, and statins, as well as long-term CCBs, significantly improves coronary microvascular function as measured by CFR in patients without obstructive CAD.
Supports ACEI/ARB use to enhance microvascular function; extends pooled evidence for CFR-targeted therapy.
Objective This study aims to investigate the impact of cardiovascular medications on the coronary flow reserve (CFR) in patients without obstructive coronary artery disease (CAD). Methods We searched PubMed, EMBASE, and Cochrane databases from inception to 15 November 2019. Studies were included if they reported CFR from baseline to follow-up after oral drug therapy of patients without obstructive CAD. Data were pooled using random-effects modeling. The primary outcome was change in CFR from baseline to follow-up after oral drug therapy. Results A total of 46 studies including 845 subjects were included in this study. Relative to baseline, the CFR was improved by angiotensin converting enzyme (ACEIs), aldosterone receptor antagonists (ARBs) (SMD: 1.12; 95%CI: 0.77 to 1.47), and statins treatments (SMD: 0.61; 95%CI: 0.36 to 0.85). 6-12 months of calcium channel blockers (CCBs) treatments improved CFR (SMD: 1.04; 95%CI: 0.51 to 1.58). Beta-blocker (SMD: 0.24; 95%CI: -0.39 to 0.88) and ranolazine treatment (SMD: 0.31; 95%CI: -0.39 to 1.01) was not associated with improved CFR. Conclusions Therapy with ACEIs, ARBs, and statins was associated with improved CFR in patients with confirmed or suspicious CMD. CCBs also improved CFR among patients followed for 6 to 12 months. Beta-blocker and ranolazine had no impact on CFR.
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Yong et al. (2020) conducted a meta-analysis in Without obstructive coronary artery disease (n=845). ACEIs and ARBs vs. Baseline was evaluated on Change in coronary flow reserve (CFR) from baseline to follow-up (SMD 1.12, 95% CI 0.77-1.47). Therapy with ACEIs and ARBs significantly improved coronary flow reserve compared to baseline (SMD 1.12) in patients without obstructive coronary artery disease.
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