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October 1, 2024Open HeartOpen Access

Long-term outcomes of ischaemia with no obstructive coronary artery disease (INOCA): a systematic review and meta-analysis

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Why the study?

The prognosis of myocardial ischaemia with no obstructive coronary artery disease and its underlying vasomotor disorders, vasospastic angina and microvascular angina, is not well defined.

Comparison

VSA vs MVA and diagnostic methods for INOCA

Design

Systematic review and meta-analysis

Follow-up

Up to 5-year follow-up

Key result

Microvascular angina was associated with a higher rate of MACE compared to vasospastic angina (2.5 vs 1.1 per 100 patient-years; P=0.025), with no significant difference in death or MI.

Authors

NONatalija OdanovićASAlexandra N. SchwannZZZhiyuan Zhang

Discussion

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Overview

INOCA carries low overall MACE risk but higher rates in MVA with reduced CFR; high heterogeneity leaves precise prognosis open.

Study Design

Type

Meta-Analysis (n=17,302)

Structured PICO

P
Population
17,302 patients with INOCA fulfilling COVADIS criteria for possible or definitive vasospastic or microvascular angina, followed for up to 5 years.
O
Outcome
Composite of all-cause death and myocardial infarction (MI), and major adverse cardiovascular event (MACE) at annual intervals up to 5-year follow-upcomposite

Main Result

Absolute Event Rate: 2.5% vs 1.1%

p-value: p=0.025

Patients with INOCA generally have a low rate of MACE, but those with microvascular angina, particularly with reduced coronary flow reserve, face a significantly higher risk compared to other subgroups.

Limitations

  • High heterogeneity among the included studies

Cite This Study

Odanović et al. (2024) conducted a meta-analysis in Ischaemia with no obstructive coronary artery disease (INOCA) (n=17,302). Microvascular angina (MVA) vs. Vasospastic angina (VSA) was evaluated on Major adverse cardiovascular event (MACE) (p=0.025). Microvascular angina was associated with a higher rate of MACE compared to vasospastic angina (2.5 vs 1.1 per 100 patient-years; P=0.025), with no significant difference in death or MI.

synapsesocial.com/papers/6a966e5176292a5bc0fbace7https://doi.org/10.1136/openhrt-2024-002852
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