Determinants of long-term clinical outcomes in patients with angina but without obstructive coronary artery disease: a systematic review and meta-analysis
Authors' conclusion
Angina without obstructive CAD has a heterogeneous prognosis. A main determinant of major adverse events is the presence of 'some' coronary atherosclerosis, with unequivocal myocardial ischaemia being associated with worse clinical outcomes.
Study context
- Population
- Patients with angina and no obstructive coronary artery disease (CAD)
- Participants
- 35,039 patients54 studies
- Outcome
- Composite of:
- All-cause death
- Non-fatal MI
- Follow-up
- Median 5 years (IQR 3-7 years)
Methodological detailsrandom-effects models, Searched PubMed, Cochrane Library, Embase and Clinical Trials Registry until January 2017
- Random-effects models
- Searched PubMed, Cochrane Library, Embase and Clinical Trials Registry until January 2017
Pooled result
As reported in the abstract
All-cause death and non-fatal MI · median follow-up 5 years
Pooled incidence
0.98/100 person-years
95% CI 0.77–1.19%
Further pooled results
| Outcome | Less-than-obstructive CAD | Entirely normal coronary arteries | P value |
|---|---|---|---|
| Primary outcome, by study population (subgroup) | 1.32/100 person-years (95% CI 1.02–1.62) | 0.52/100 person-years (95% CI 0.34–0.79) | P < 0.01 |
Determinants of primary outcome
- Associated with dyslipidaemia
- P = 0.016
- Associated with diabetes
- P = 0.035
- Associated with hypertension
- P = 0.016
- Ischaemia documented by non-invasive imaging associated with higher incidence
- P = 0.02
- No significant difference between studies enrolling only documented ischaemia and those regardless of ischaemia
Recurrent hospitalization
- High incidence of recurrent hospitalization
Original publication
Determinants of long-term clinical outcomes in patients with angina but without obstructive coronary artery disease: a systematic review and meta-analysis. Eur Heart J. Published 23 April 2018. doi:10.
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