What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Without obstructive coronary artery disease (n=845). Intervention: ACEIs and ARBs vs. Baseline. Primary outcome: Change in coronary flow reserve (CFR) from baseline to follow-up (SMD 1.12, 95% CI 0.77-1.47).

October 30, 2020Open Access

Effects of Oral Drugs on Coronary Microvascular Function in Patients Without Significant Stenosis of Epicardial Coronary Arteries: A Systematic Review and Meta-Analysis of Coronary Flow Reserve

JYJingwen YongPeking University JTJinfan TianCardiac Imaging XYXueyao YangHunan Normal University

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.

Study Design

Type

Meta-Analysis (n=845)

Structured PICO

Does oral drug therapy improve coronary flow reserve in patients without significant stenosis of epicardial coronary arteries?

Population

845 adults without obstructive coronary artery disease from 46 studies, evaluated for changes in coronary flow reserve before and after oral drug therapy with follow-up ranging from 0.75 to 12 months.

Intervention

Oral drug therapy including angiotensin-converting enzyme inhibitors (ACEIs), aldosterone receptor antagonists (ARBs), statins, calcium channel blockers (CCBs), beta-blockers, or ranolazine for at least 3 weeks.

Comparator

Baseline (pre-treatment coronary flow reserve)

Outcome

Change in coronary flow reserve (CFR) from baseline to follow-up after oral drug therapysurrogate

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.

Main Result

Standardized Mean Difference: 1.12 (95% CI 0.77–1.47)

Limitations

Not all patients had confirmed coronary microvascular dysfunction.
No uniform detection method for measuring coronary flow reserve across studies.
Differences in test drugs or administration methods during measurement.
Limited number of studies used clinical symptoms as an outcome.

Abstract

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. Keywords: Oral drug, coronary microvascular, microvascular function, coronary flow reserve

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