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Long-Term Clinical Impact of Patients with Multi-Vessel Non-Obstructive Coronary Artery Disease
Jin Jung1, Su-Nam Lee1, Sung-Ho Her1
1Department of Cardiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea.
Insights
Multi-vessel non-obstructive coronary artery disease (CAD) poses a significant long-term risk, particularly with three diseased vessels. This finding highlights the need for intensified management strategies in affected patients.
Area of Science:
- Cardiology
- Vascular Medicine
- Clinical Research
Background:
- Non-obstructive coronary artery disease (CAD) is frequently diagnosed but its long-term impact, especially multi-vessel involvement, remains understudied.
- Understanding the clinical sequelae of non-obstructive CAD is crucial for patient management.
Purpose of the Study:
- To investigate the long-term clinical impact of multi-vessel non-obstructive CAD.
- To assess the association between the number of diseased vessels and major adverse cardiovascular and cerebrovascular events (MACCEs).
Main Methods:
- 2083 patients without prior revascularization or obstructive CAD were categorized by the number of diseased vessels (0, 1, 2, or 3) with 25% ≤ luminal stenosis < 70%.
- Patients were followed for 5 years, with MACCEs (cardiac death, stroke, myocardial infarction) as the primary outcome.
- Statistical analysis was performed to adjust for confounding factors.
Main Results:
- MACCEs incidence rose with an increasing number of non-obstructive diseased vessels, peaking in the three-vessel group.
- Patients with three diseased vessels demonstrated significantly worse outcomes for MACCEs, stroke, and myocardial infarction compared to those with zero diseased vessels, even after adjustment.
Conclusions:
- Multi-vessel non-obstructive CAD, particularly involving three vessels, is strongly linked to adverse long-term clinical outcomes.
- These findings suggest that patients with multi-vessel non-obstructive CAD may benefit from more aggressive treatment strategies.
Background:
Non-obstructive coronary artery disease (CAD) is a disease commonly diagnosed in patients undergoing coronary angiography. However, little is known regarding the long-term clinical impact of multi-vessel non-obstructive CAD. Therefore, the object of this study was to investigate the long-term clinical impact of multi-vessel non-obstructive CAD.
Method:
A total of 2083 patients without revascularization history and obstructive CAD were enrolled between January 2010 and December 2015. They were classified into four groups according to number of vessels involved in non-obstructive CAD (25% ≤ luminal stenosis < 70%): zero, one, two, or three diseased vessels (DVs). We monitored the patients for 5 years. The primary outcome was major cardiovascular and cerebrovascular events (MACCEs), defined as a composite of cardiac death, stroke, and myocardial infarction (MI).
Result:
The occurrence of MACCEs increased as the number of non-obstructive DVs increased, and was especially high in patients with three DVs. After adjustment, patients with three DVs still showed significantly poorer clinical outcomes of MACCEs, stroke, and MI compared those with zero DVs.
Conclusion:
Multi-vessel non-obstructive CAD, especially in patients with non-obstructive three DVs, is strongly associated with poor long-term clinical outcomes. This finding suggests that more intensive treatment may be required in this subset of patients.
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