The prognosis of patients with symptoms of angina (with all their subjectivity) in a setting of no significant coronary lesions is widely varied. It is not as benign as we initially thought and patients do not present as many events as “regular” patients with associated severe coronary lesions.
The literature owed us data on the long-term prognosis for these patients and that is precisely the subject matter of this work that was recently published in the European Heart Journal.
The authors searched for studies published on the subject up to 2017 that included the events all-cause death and nonfatal infarction. This meta-analysis included 54 studies with a total of 35,039 patients (mean age 56 years, male/female ratio: 0.51), all of them with typical angina symptoms and no significant coronary lesions.
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After a 5-year follow-up (range: 3 to 7 years), the pooled global incidence of death and infarction was 0.98/100 person-years, with considerable heterogeneity among studies (p < 0.001).
The primary endpoint was associated with the presence of dyslipidemia (p = 0.016), diabetes (p = 0.035), and hypertension (p = 0.016). Studies enrolling patients with non-obstructive or non-significant coronary lesions, in angiographic terms, showed more events (1.32/100 person-years) than studies including only patients with entirely normal coronary arteries (0.52/100 person-years). However, there were no differences between studies enrolling patients with documented myocardial ischemia and studies that did not contemplate this pathology as a variable in the protocol.
In any case, ischemia documented by non-invasive imaging techniques was associated with a higher rate of events (p = 0.02).
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The Achilles’ heel for these patients is definitely the high rate of recurrent hospitalization due to angina, which often results in catheterization confirming the results of prior catheterizations: coronary arteries with no angiographically significant lesions.
Conclusion
The prognosis for patients with angina without significant lesions is heterogeneous. The main determinant of adverse events is the presence of “some” atherosclerosis and positive functional tests for ischemia in any area. The quality of life of these patients is affected by the high incidence of hospitalization, recurrent angina, and repeated catheterizations.
Original title: Determinants of Long-Term Clinical Outcomes in Patients with Angina but Without Obstructive Coronary Artery Disease: A Systematic Review and Meta-Analysis.
Reference: Francesco Radico et al. Eur Heart J. 2018 Jun 14;39(23):2135-2146.
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