Clinical Characteristics, Sex Differences, and Outcomes in Patients With Normal or Near‐Normal Coronary Arteries, Non‐Obstructive or Obstructive Coronary Artery Disease

Ouellette, Michelle L.; Löffler, A; Beller, George A.; Workman, Virginia; Holland, Eric; Bourque, Jamieson M.

doi:10.1161/jaha.117.007965

Cited by 38 publications

(48 citation statements)

References 35 publications

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“…Следовательно, чем менее тяжелая клиническая картина ИБС наблюдается у пациентки, тем больше внимания должно быть уделено обследованию, предшествующему КАГ [20,21]. Причем критерии направления на это обследование закономерно могут иметь ряд особенностей в условиях различных регионов, определяясь как медико-биологическими характеристиками популяции, так и техническими и экономическими условиями.…”

Section: Discussionunclassified

“…Спазм КА был выявлен у 17 из 40 пациенток без видимого атеросклеротического поражения, что может указывать на иные механизмы развития приступа стенокардии. Наличие верифицированного спазма КА ассоциировалось с получением положительного результата в тесте с физической нагрузкой, что может оказать влияние на тактику лечения данных пациентов [6,17,18,21].…”

Section: Discussionunclassified

“…Полученные данные отражают актуальность разработки более эффективных алгоритмов диагностики ИБС у женщин, поскольку гендерные особенности формирования коронарного атеросклероза четко были подтверждены в целом ряде крупных исследований, включенных в метаанализ [17,21,25].…”

Section: Discussionunclassified

“…Полученные данные подтверждают важное прогностическое значение СД 2-го типа, наличие которого является маркером высокого риска развития ИБС [14,16]. Кроме того, в последние годы широко обсуждаются генетические маркеры неблагоприятного жизненного прогноза у лиц без обструкции коронарных сосудов, страдающих стенокардией напряжения и перенесших инфаркт миокарда [17][18][19][20][21][22][23].…”

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Analysis of the effectiveness of selection of women for coronarography in real clinical practice

2019

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Objective: evaluation of the effectiveness of selection for coronary angiography of women who have applied to a cardiologist for thoracalgia and dorsalgia and regarded primarily as having a clinic of stable angina.Materials and methods. 108 women (median age 59.5) applying to cardiologist due to chest pain were included in a cross-sectional study and underwent coronary angiography. Subjects with identified clinically significant atherosclerotic coronary lesions were compared to persons with intact coronary arteries.Results. One-, two- and three-vessel lesions were diagnosed in accordingly 16; 21 and 26 % of patients. Intact coronary arteries were detected in 37 % subjects. In 17 of 40 persons with intact structure of the coronary arteries spasm of the coronary arteries was diagnosed. Odds ratio for atherosclerotic coronary arteries lesions in type 2 diabetic persons were 7.91 (1.74–36.00), for hypertension odds ratio 4.79 (1.52–15.01). Severe angina (3 and 4 functional class) was significantly more often diagnosed in women with identified coronary atherosclerosis. Severe coronary atherosclerosis was associated with absence of negative or doubtful results, whereas intact coronary vessels, negative and questionable results revealed more than half of the women. The obtained data reflect the relevance of the development of more effective algorithms for diagnosis of coronary artery disease in women, since the gender peculiarities of the formation of coronary atherosclerosis have been clearly confirmed in a number of large studies.Conclusion. Medical history, physical load tests results, and subject’s emotional status should be evaluated to assess the feasibility of coronary angiography.

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Analysis of the effectiveness of selection of women for coronarography in real clinical practice

2019

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“…From the concept and clinical setting, CSX and CSF seem to be included in MVA, of which the pathogenesis is mainly related with CMD. About half of individuals with angina or ischemic heart disease are fail to be diagnosed of CAD [6,28]. The related diseases including CSX and CSF due to CMD would be better uniformly named as MVA for better communication and investigation.…”

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confidence: 99%

Coronary Microvascular Dysfunction and Microvascular Angina

Sun

Wang

2019

ijcp

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Many patients present with myocardial ischemic symptoms, but fail to be diagnosed of obstructed coronary artery disease, since the normal coronary arteries or no any atherosclerosis stenosis ≥ 50% at coronary angiography. Myocardial ischemia can be caused by either abnormalities of epicardial coronary arteries or coronary microvascular dysfunction (CMD). Patient with microvascular angina in the absence of coronary artery disease and myocardial diseases, CMD is suggested to be the unique cause of symptoms. The previous clinical and pathogenetic classification of CMD is based on presence or absence of coronary artery disease, myocardial diseases, or other traditional risk factors, which would obscure the importance of the disease primarily provoked by CMD. The role of atherosclerotic plaque rupture in epicardial coronary arteries and the abnormality of hemorheology (especially in perimenopausal women) should be more stressed in the pathogenetic mechanism of CMD. The pathogenetic mechanism of CMD will be classified according to microvascular structure (embolization and stenosis), microvascular function and blood risk factors in this paper. The CMD related diseases including cardiac X syndrome and coronary slow flow would be better uniformly named as microvascular angina. While little data supported therapies for CMD related diseases so far, the blood healthy therapy as a novel method is recommended to treat microvascular angina, especially in the patients with high hematocrit, increased blood viscosity and coronary slow flow.

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Long‐term outcomes in patients with normal coronary arteries, nonobstructive, or obstructive coronary artery disease on invasive coronary angiography

Hanson

Prasad

et al. 2021

Clinical Cardiology

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Background Normal or near normal coronary arteries (NNCA) or nonobstructive coronary artery disease (CAD) are commonly found on invasive coronary angiography (ICA). Hypothesis We aimed to determine long‐term outcomes by severity of CAD in a contemporary cohort of patients undergoing ICA for evaluation for ischemic heart disease. Methods We assessed a consecutive cohort of 925 patients who underwent non‐emergent ICA over 24 months. Cardiac death (CD), nonfatal myocardial infarction (NFMI), late revascularization, and medication use were assessed. Results Follow‐up data was available in 850 patients. Of patients without heart failure, at a median of 6.0 years, there was a significant decrease in survival free from CD or NFMI, and from all cardiac events, for those with obstructive CAD compared with patients with NNCAs or nonobstructive CAD (p < .001 for both). No differences between NNCA and nonobstructive CAD patients in rates of CD or NFMI (2.0% vs. 2.1%/year, p = .58) or all cardiac events (2.4% vs. 2.9%/year, p = .84) were observed. Conclusion Long‐term follow‐up in a contemporary cohort of consecutive patients undergoing non‐emergent ICA for detection of CAD showed no difference in annual rates of CD or NFMI, or total cardiac events, in patients with NNCAs versus those with nonobstructive CAD, whereas patients with obstructive CAD had significantly more events. Event rates were low and similar by gender. Use of aspirin, lipid lowering therapy, and beta‐blockers increased in all subgroups after ICA. We speculate this may explain the low incidence of subsequent cardiac events, and similar event rates in patients with NNCA and nonobstructive CAD, even in patients presenting with non‐ST‐elevation MI.

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Clinical Characteristics, Sex Differences, and Outcomes in Patients With Normal or Near‐Normal Coronary Arteries, Non‐Obstructive or Obstructive Coronary Artery Disease

Cited by 38 publications

References 35 publications

Analysis of the effectiveness of selection of women for coronarography in real clinical practice

Analysis of the effectiveness of selection of women for coronarography in real clinical practice

Coronary Microvascular Dysfunction and Microvascular Angina

Long‐term outcomes in patients with normal coronary arteries, nonobstructive, or obstructive coronary artery disease on invasive coronary angiography

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