Key result
Low coronary flow reserve was associated with a significantly higher risk of death (HR 2.45) and major adverse cardiac events (HR 2.08) in patients with non-obstructive coronary artery disease.
Why the study?
The prognosis of patients with non-obstructive coronary artery disease and coronary microvascular disease assessed as low coronary flow reserve according to imaging modalities and sex difference remained unclear.
Does low coronary flow reserve predict increased risk of death and MACE in patients with non-obstructive coronary artery disease?
Meta-Analysis (n=15,979)
Does low coronary flow reserve predict increased risk of death and MACE in patients with non-obstructive coronary artery disease?
Hazard Ratio: 2.45 (95% CI 1.37–3.53)
p-value: p=<0.001
Low coronary flow reserve is an independent predictor of poor outcomes, including death and MACE, in patients with non-obstructive coronary artery disease regardless of sex.
Low CFR marks higher-risk non-obstructive CAD patients; supports prognostic use but leaves open whether CFR-targeted therapy improves outcomes.
Pupose: To clarify prognosis of patients with non-obstructive coronary artery disease (NOCAD) and coronary microvascular disease (CMD) assessed as low coronary flow reserve (CFR) according to imaging modalities and sex difference. Methods: Comprehensive systematic literature review and meta-analyses were conducted. Risk of death and major adverse cardiac events (MACE) were pooled and compared in patients with abnormally low versus normal CFR using cut-off limits 2.0-2.5. Random effects model used for estimation of odds ratios (OR) and hazard ratios (HR) with 95% confidence interval (CI). Results: Nineteen eligible observational studies provided data for death and MACE, publication bias was insignificant, p=0.62. Risk of death and MACE were significantly higher in patients with low (n=4.612, 29%) than normal CFR (n=11.367, 71%): using transthoracal echocardiography (TTE) (OR 4.25 (95%CI: 2.94, 6.15) p<0.001) and (OR 6.98 (95% CI:2.56, 19.01) p<0.001), positron emission tomography (PET) (OR 2.51 (CI 95%: 1.40, 4..49) p=0.002) and (OR 2.87 (95%CI: 2.16, 3.81) p<0.001), and invasive intracoronary assessment (OR 2.23 (95%CI: 1.15, 4.34) p<0.018), and (OR 4.61 (95%CI: 2.51, 8.48) p<0.001), respectively. Pooled adjusted HR for death and MACE were (HR 2.45(95%CI: 1.37, 3.53) p<0.001) and (HR 2.08 (95%CI: 1.54, 2.63) p<0.001) respectively. Studies comparing men and women with abnormally low CFR demonstrated similar worse prognosis in both sexes. Conclusion: Low CFR is associated with poorer prognosis in patients with NOCAD regardless of sex. TTE may overestimate risk of death and MACE, while PET seems to be more appropriate. Future studies are needed to consolidate the current evidence.
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Jensen et al. (2023) conducted a meta-analysis in Non-obstructive coronary artery disease (NOCAD) and coronary microvascular disease (CMD) (n=15,979). Low coronary flow reserve (CFR) vs. Normal coronary flow reserve (CFR) was evaluated on Death (HR 2.45, 95% CI 1.37, 3.53, p=<0.001). Low coronary flow reserve was associated with a significantly higher risk of death (HR 2.45) and major adverse cardiac events (HR 2.08) in patients with non-obstructive coronary artery disease.
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