Clinical outcomes of patients with coronary microvascular dysfunction in absence of obstructive coronary
Antonio De Vita1, Carmine Pizzi2, Isabella Tritto3
1Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Dipartimento di Medicina Cardiovascolare, Rome.
Insights
Coronary microvascular dysfunction (CMD) causes chest pain in patients with normal arteries. Prognosis varies: excellent for microvascular angina, but needs more study in acute coronary syndromes.
Area of Science:
- Cardiology
- Vascular Medicine
Background:
- Many patients with chest pain have normal coronary arteries on angiography.
- Coronary microvascular dysfunction (CMD) is increasingly recognized as a cause of angina in these individuals.
- Prognosis for patients with non-obstructive coronary artery disease and angina is debated.
Purpose of the Study:
- To critically review studies on the clinical outcomes of patients with angina and non-obstructive coronary artery disease.
- To assess the prognostic impact of coronary microvascular dysfunction (CMD) in different clinical presentations.
Main Methods:
- Review of published literature on clinical outcomes.
- Analysis of studies involving patients with stable angina or acute coronary syndrome and normal/near-normal coronary arteries.
- Focus on studies assessing the role of coronary microvascular dysfunction (CMD).
Main Results:
- Patient populations in studies are heterogeneous.
- Presence of non-obstructive atherosclerotic coronary artery disease significantly impacts clinical outcome.
- Long-term prognosis appears excellent for patients with totally normal coronary arteries and CMD-related stable angina (microvascular angina).
Conclusions:
- The prognosis for patients with angina and non-obstructive coronary artery disease depends heavily on the underlying coronary pathology.
- Microvascular angina in patients with completely normal coronary arteries has an excellent long-term prognosis.
- Further research is needed to clarify the prognostic impact of CMD in patients presenting with acute coronary syndromes.
Abstract:
Up to 50% of patients presenting with stable, mainly exercise-induced, chest pain and 10-20% of those admitted to hospital with chest pain suggesting an acute coronary syndrome show normal or near-normal coronary arteries at angiography. Coronary microvascular dysfunction (CMD) is a major cause of symptoms in these patients. However, controversial data exist about their prognosis. In this article, we critically review characteristics and results of the main studies that assessed clinical outcome of patients with angina chest pain and nonobstructive coronary artery disease presenting with either a stable angina pattern or an acute coronary syndrome. Published data indicate that the patients included in most studies are heterogeneous and a major determinant of clinical outcome is the presence of atherosclerotic, albeit not obstructive, coronary artery disease. Long-term prognosis seems instead excellent in patients with totally normal coronary arteries and a syndrome of CMD-related stable angina (microvascular angina). On the other hand, the prognostic impact of CMD in patients presenting with an acute coronary syndrome needs to be better assessed in future studies.
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