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Reduced survival in patients with "coronary microvascular disease"
Terence Lin1, Stephen Rechenmacher, Shuja Rasool
1Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California.
Insights
Coronary microvascular disease (µVD) is a common cause of chest pain with abnormal stress tests. Patients with µVD have worse survival than the general population but better survival than those with significant epicardial coronary artery disease.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Testing
Background:
- Coronary microvascular disease (µVD) is frequently implicated in patients presenting with chest pain, abnormal stress tests, and non-obstructive coronary artery disease (CAD).
- This condition leads to significant healthcare utilization and costs, yet its long-term prognostic implications remain unclear.
- Understanding the survival impact of µVD is crucial for patient management and risk stratification.
Purpose of the Study:
- To investigate the long-term survival outcomes of patients diagnosed with coronary microvascular disease (µVD) presenting with chest pain and abnormal stress tests.
- To compare the mortality rates of patients with µVD against those with significant epicardial coronary artery disease (CAD) and age- and gender-matched controls.
Main Methods:
- A cohort of 9941 patients undergoing exercise stress tests for chest pain evaluation was retrospectively analyzed.
- 935 patients with positive stress tests and coronary angiograms within one year were included.
- Patients were categorized into significant epicardial CAD (≥70% stenosis) or coronary µVD (no significant stenosis).
Main Results:
- Patients with coronary µVD (n=611) were younger and exhibited distinct demographic and physiological characteristics compared to those with significant epicardial CAD (n=324).
- All-cause mortality was significantly higher in the coronary µVD group compared to age- and gender-matched population controls (p < 0.0001).
- However, patients with coronary µVD demonstrated better survival rates than those with significant epicardial CAD.
Conclusions:
- Coronary microvascular disease (µVD) is a prevalent diagnosis in patients with chest pain and positive stress tests, often without significant epicardial coronary artery disease.
- While associated with increased mortality compared to the general population, µVD carries a more favorable long-term survival prognosis than significant obstructive coronary artery disease.
Abstract:
The syndrome of chest pain, abnormal stress test, and nonflow limiting coronary artery disease (CAD) is common and is attributed to coronary microvascular disease (µVD). It is associated with increased hospital admissions and health care costs. But its impact on long-term survival is not known. Of the 9941 consecutive patients who had an exercise stress test for evaluation of chest pain between May 1991 and July 2007, 935 had both a positive stress test and a coronary angiogram within 1 year of their stress test forming the study cohort. Significant angiographic CAD defined as ≥70% stenosis of an epicardial coronary artery or ≥50% stenosis of the left main coronary artery was present in 324 patients. Rest (n = 611) were considered to have coronary µVD. Compared with patients with significant epicardial CAD, patients with coronary µVD were younger (63 ± 11 vs. 65 ± 10 years, p = 0.002), and had lower left ventricular wall thickness (p < 0.02), systolic blood pressure (BP; p = 0.002), pulse pressure (0.0008), systolic BP with exercise (p = 0.0001), and pulse pressure with exercise (p < 0.0001). Those with coronary µVD had a better survival compared with those with significant epicardial CAD, but worse than that expected for age- and gender-matched population (p < 0.0001). Coronary µVD as a cause of chest pain and positive stress test is common. All-cause mortality in patients with coronary µVD is worse than in an age- and gender-matched population control, but better than those with significant epicardial CAD.
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