Original articlePrevalence and Prognosis of Nonobstructive Coronary Artery Disease in Patients Undergoing Coronary Angiography or Coronary Computed Tomography Angiography: A Meta-Analysis
Section snippets
Search Strategy
The guideline of the MOOSE (Meta-analysis of Observational Studies in Epidemiology)8 was followed for the conduct of the present systematic review and meta-analysis. We searched PubMed, EMBASE, and the Cochrane Library for the current literature. Detailed search strategies are given in Supplemental Methods (available online at http://www.mayoclinicproceedings.org). The last search was performed on November 1, 2015. Reference lists from these identified reports and reviews were manually screened
Results
Our literature search yielded 2682 relevant articles after duplication removal, of which 103 articles warranted full-text review for detail. After exclusion, we finally identified 54 studies that met the inclusion criteria and provided at least 1 end point of interest (Figure 1). Of these 54 studies, 44 studies with 1,394,057 patients reported prevalence of nonobstructive CAD and 41 studies with 309,311 patients reported at least 1 of the clinical outcomes of interest (median follow-up 27.6
Discussion
To our knowledge, this is the first comprehensive review of the current literature in a meta-analytic approach, assessing the prevalence, clinical characteristics, and prognostic value of nonobstructive CAD in patients referred for CA or CCTA. In this meta-analysis, we found that those with nonobstructive CAD accounts for 67% of patients with stable angina and 13% of patients with NSTE-ACS. Patients with nonobstructive CAD overall have a better prognosis than do those with obstructive CAD, but
Conclusion
In this meta-analysis, we found that nonobstructive CAD is common and that the prevalence varies depending on sex, clinical setting, and risk profile. Patients with mild CAD, identified by either CA or CCTA, have a lower risk of hard cardiac events than do those with obstructive CAD but a higher risk of events than do those with no angiographic CAD. Given the impaired prognosis and heterogeneity of mechanisms, more comprehensive evaluation is proposed. Further research is warranted to determine
Acknowledgments
We thank Fu Ying Tian, PhD, and Yi Zhou, MD, MPH, for their assistance with statistical analyses and Charles Resor, MD, MSc, for his assistance with editing and formatting the manuscript.
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For editorial comment, see page 323
Grant Support: This work was supported by the Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (grant no. ZYLX201303), the National Key Clinical Specialty Construction Project (2013-2014), and the “Beijing Municipal Administration of Hospitals” Ascent Plan (code DFL20150601).