TY - JOUR
T1 - Meta-analysis and systematic review of coronary vasospasm in ANOCA patients
T2 - Prevalence, clinical features and prognosis
AU - Woudstra, Janneke
AU - Vink, Caitlin E. M.
AU - Schipaanboord, Diantha J. M.
AU - Eringa, Etto C.
AU - den Ruijter, Hester M.
AU - Feenstra, Rutger G. T.
AU - Boerhout, Coen K. M.
AU - Beijk, Marcel A.M.
AU - de Waard, Guus A.
AU - Ong, Peter
AU - Seitz, Andreas
AU - Sechtem, Udo
AU - Piek, J.J.
AU - van de Hoef, T.P.
AU - Appelman, Yolande
N1 - Funding Information:
TH received an institutional research grant from Philips. JP is consultant for Philips. US and PO received honoraria from Abbott and Philips for speaking about coronary function testing. MB received an institutional research grant from Actelion B.V.
Publisher Copyright:
2023 Woudstra, Vink, Schipaanboord, Eringa, den Ruijter, Feenstra, Boerhout, Beijk, de Waard, Ong, Seitz, Sechtem, Piek, van de Hoef and Appelman.
PY - 2023
Y1 - 2023
N2 - Background: Coronary artery spasm (CAS), encompassing epicardial and microvascular spasm, is increasingly recognized as cause of angina in patients with non-obstructive coronary artery disease (ANOCA). However, various spasm provocation testing protocols and diagnostic criteria are used, making diagnosis and characterization of these patients difficult and interpretation of study results cumbersome. This review provides a structured overview of the prevalence, characterization and prognosis of CAS worldwide in men and women. Methods: A systematic review identifying studies describing ANOCA patients with CAS was performed. Multiple outcomes (prevalence, clinical features, and prognosis) were assessed. Data, except for prognosis were pooled and analysed using random effects meta-analysis models. Results: Twenty-five publications (N = 14.554) were included (58.2 years; 44.2% women). Percentages of epicardial constriction to define epicardial spasm ranged from >50% to >90%. Epicardial spasm was prevalent in 43% (range 16–73%), with a higher prevalence in Asian vs. Western World population (52% vs. 33%, p = 0.014). Microvascular spasm was prevalent in 25% (range 7–39%). Men were more likely to have epicardial spasm (61%), women were more likely to have microvascular spasm (64%). Recurrent angina is frequently reported during follow-up ranging from 10 to 53%. Conclusion: CAS is highly prevalent in ANOCA patients, where men more often have epicardial spasm, women more often have microvascular spasm. A higher prevalence of epicardial spasm is demonstrated in the Asian population compared to the Western World. The prevalence of CAS is high, emphasizing the use of unambiguous study protocols and diagnostic criteria and highlights the importance of routine evaluation of CAS in men and women with ANOCA. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=272100.
AB - Background: Coronary artery spasm (CAS), encompassing epicardial and microvascular spasm, is increasingly recognized as cause of angina in patients with non-obstructive coronary artery disease (ANOCA). However, various spasm provocation testing protocols and diagnostic criteria are used, making diagnosis and characterization of these patients difficult and interpretation of study results cumbersome. This review provides a structured overview of the prevalence, characterization and prognosis of CAS worldwide in men and women. Methods: A systematic review identifying studies describing ANOCA patients with CAS was performed. Multiple outcomes (prevalence, clinical features, and prognosis) were assessed. Data, except for prognosis were pooled and analysed using random effects meta-analysis models. Results: Twenty-five publications (N = 14.554) were included (58.2 years; 44.2% women). Percentages of epicardial constriction to define epicardial spasm ranged from >50% to >90%. Epicardial spasm was prevalent in 43% (range 16–73%), with a higher prevalence in Asian vs. Western World population (52% vs. 33%, p = 0.014). Microvascular spasm was prevalent in 25% (range 7–39%). Men were more likely to have epicardial spasm (61%), women were more likely to have microvascular spasm (64%). Recurrent angina is frequently reported during follow-up ranging from 10 to 53%. Conclusion: CAS is highly prevalent in ANOCA patients, where men more often have epicardial spasm, women more often have microvascular spasm. A higher prevalence of epicardial spasm is demonstrated in the Asian population compared to the Western World. The prevalence of CAS is high, emphasizing the use of unambiguous study protocols and diagnostic criteria and highlights the importance of routine evaluation of CAS in men and women with ANOCA. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=272100.
KW - ANOCA
KW - acetylcholine provocation test
KW - coronary vasospasm
KW - microcirculation
KW - sex
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85150912260&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/36993994
U2 - 10.3389/fcvm.2023.1129159
DO - 10.3389/fcvm.2023.1129159
M3 - Review article
C2 - 36993994
SN - 2297-055X
VL - 10
JO - Frontiers in cardiovascular medicine
JF - Frontiers in cardiovascular medicine
M1 - 1129159
ER -