15-Year Cardiovascular Risk in Patients With Angina Without Obstructive Coronary Arteries

According to international guidelines, patients with angina and no obstructive coronary artery disease (ANOCA) are at elevated risk for adverse clinical events.

The aim of this study was to examine 15-year cardiovascular risk in patients with ANOCA referred for coronary angiography because of stable angina pectoris compared with a matched general population cohort without histories of coronary artery disease.

This cohort study included all patients suspected of having stable angina pectoris and referred for coronary angiography from 2003 to 2021 but who had no or mild coronary artery disease. Myocardial infarction, ischemic stroke, and death outcomes were compared with those in 1:5 age- and sex-matched individuals from the general population without known coronary artery disease. Fifteen-year risk differences were computed, accounting for competing risk for death in the ischemic outcomes. Age- and sex-stratified analyses were performed. The maximum and median follow-up times were 15 and 10.7 years, respectively.

The ANOCA cohort (n = 21,132) and the general population cohort (n = 105,660) had similar 15-year cumulative incidence of myocardial infarction (3.5% vs 3.5%; risk difference [RD]: 0.0%; 95% CI: -0.3% to 0.4%) and higher ischemic stroke risk (3.7% vs 2.9%; RD: 0.8%; 95% CI: 0.5%-1.2%) but slightly lower mortality (25.4% vs 26.4%; RD: -0.9%; 95% CI: -1.8% to -0.1%). Men and older (≥75 years of age) patients had the lowest risks compared with the matched general population cohort.

Patients with ANOCA have a similar risk for myocardial infarction, lower mortality, and a marginally higher risk for ischemic stroke than the general population. Results were age and sex dependent.