Clinical characteristics and prognosis of patients with microvascular angina: an international and prospective cohort study by the Coronary Vasomotor Disorders International Study (COVADIS) Group

• Type of Material: Article
• Authors: Hiroaki Shimokawa, Tohoku University; Akira Suda, Tohoku University; Jun Takahashi, Tohoku University; Colin Berry, University of Glasgow; Paolo G Camici, Vita Salute University and San Raffaele Hospital; Filippo Crea, Università Cattolica del Sacro Cuore; Javier Escaned, Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid; Tom Ford, University of Glasgow; Eric Yii, University of Glasgow; Juan C Kaski, St Georges University London; Takahiko Kiyooka, Tokai University Oiso Hospital; Puja Mehta, Emory University; Peter Ong, Robert-Bosch-Krankenhaus; Yukio Ozaki, Fujita Health University School of Medicine; Carl Pepine, University of Florida; Ornella Rimoldi, Consiglio Nazionale delle Ricerche; Basmah Safdar, Yale University; Udo Sechtem, Robert Bosch Krankenhaus; Kenichi Tsujita, Kumamoto University; Satoshi Yasuda, Tohoku University; John F Beltrame, University of Adelaide; Noel Bairey C Merz, Cedars-Sinai Medical Center
• Language: English
• Date: 2021-05-26
• Publisher: OXFORD UNIV PRESS
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/eurheartj/ehab282
• Title of Journal or Parent Work: EUROPEAN HEART JOURNAL
• Volume: 42
• Issue: 44
• Start Page: 4592
• End Page: 4600
• Grant/Funding Information: The Japanese Coronary Spasm Association (funded by the Japan Heart Foundation). The British Heart Foundation (PG/17/2532884; RE/18/6134217 to. C.B.); The National Heart, Lung and Blood Institutes (N01-HV-68161, N01-HV-68162, N01-HV-68163, N01-HV-68164, grants U0164829, U01 HL649141, U01 HL649241, K23HL105787, T32HL69751, R01 HL090957, 1R03AG032631) from the National Institute on Aging, GCRC (MO1-RR00425) from the National Center for Research Resources, the National Center for Advancing Translational Sciences (UL1TR000124 and UL1TR000064 to C.N.B.M. and C.J.P.); Funding from The Hospital Research Foundation to J.B.; the Berthold-Leibinger-Foundation, Germany to P.O. and U.S.
• Keywords: DYSFUNCTION; Cardiac & Cardiovascular Systems; Life Sciences & Biomedicine; HEART; ABNORMALITIES; Coronary microvascular dysfunction; Microvascular angina; Prognosis; CHEST PAIN; Science & Technology; ARTERY-DISEASE; CARDIAC SYNDROME-X; Cardiovascular System & Cardiology; FLOW RESERVE; ISCHEMIA
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Aims: To provide multi-national, multi-ethnic data on the clinical characteristics and prognosis of patients with microvascular angina (MVA). Methods and results: The Coronary Vasomotor Disorders International Study Group proposed the diagnostic criteria for MVA. We prospectively evaluated the clinical characteristics of patients according to these criteria and their prognosis. The primary endpoint was the composite of major cardiovascular events (MACE), verified by institutional investigators, which included cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization due to heart failure or unstable angina. During the period from 1 July 2015 to 31 December 2018, 686 patients with MVA were registered from 14 institutes in 7 countries from 4 continents. Among them, 64% were female and the main ethnic groups were Caucasians (61%) and Asians (29%). During follow-up of a median of 398 days (IQR 365-744), 78 MACE occurred (6.4% in men vs. 8.6% in women, P = 0.19). Multivariable Cox proportional hazard analysis disclosed that hypertension and previous history of coronary artery disease (CAD), including acute coronary syndrome and stable angina pectoris, were independent predictors of MACE. There was no sex or ethnic difference in prognosis, although women had lower Seattle Angina Questionnaire scores than men (P < 0.05). Conclusions: This first international study provides novel evidence that MVA is an important health problem regardless of sex or ethnicity that a diagnosis of MVA portends a substantial risk for MACE associated with hypertension and previous history of CAD, and that women have a lower quality of life than men despite the comparable prognosis.