title: The Prognosis of Patients With Nonobstructive Coronary Artery Disease Versus Normal Arteries Determined by Invasive Coronary Angiography or Computed Tomography Coronary Angiography: A Systematic Review.
abstract: Limited data exist regarding the outcomes of patients with nonobstructive coronary artery disease (CAD) detected by computed tomography coronary angiography (CTCA) or invasive coronary angiography (ICA). Our aim was to compare the prognosis of patients with nonobstructive coronary artery plaques with that of patients with entirely normal arteries. The MEDLINE, Cochrane Library, and Embase databases were searched. Studies comparing the prognosis of individuals with nonobstructive CAD versus normal coronary arteries detected by CTCA or ICA were included. The primary outcome was major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, hospitalization due to unstable angina or revascularization. A fixed effects model was chosen to pool the estimates of odds ratios (ORs). Forty-eight studies with 64,905 individuals met the inclusion criteria. Patients in the nonobstructive CAD arm had a significantly higher risk of MACE compared to their counterparts in the normal artery arm (pooled OR, 3.17, 95% confidence interval, 2.77-3.63). When excluding revascularization as an endpoint, hard cardiac composite outcomes were also more frequent among patients with nonobstructive CAD (pooled OR, 2.10; 95%CI, 1.79-2.45). All subgroups (age, sex, follow-up duration, different outcomes, diagnostic modality, and CAD risk factor) consistently showed a poorer prognosis with nonobstructive CAD than with normal arteries. When dividing the studies into a CTCA and ICA group for further analysis based on the indications for diagnostic tests, we also found nonobstructive CAD to be associated with a higher risk of MACE in both stable and acute chest pain. Patients with nonobstructive CAD had a poorer prognosis compared with their counterparts with normal arteries.
authors.affiliation: From the Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Fang-Yang
authors.initials: FY
authors.lastname: Huang
authors.forename: Bao-Tao
authors.initials: BT
authors.lastname: Huang
authors.forename: Wen-Yu
authors.initials: WY
authors.lastname: Lv
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.forename: Yong
authors.initials: Y
authors.lastname: Peng
authors.forename: Tian-Li
authors.initials: TL
authors.lastname: Xia
authors.forename: Peng-Ju
authors.initials: PJ
authors.lastname: Wang
authors.forename: Zhi-Liang
authors.initials: ZL
authors.lastname: Zuo
authors.forename: Rui-Shuang
authors.initials: RS
authors.lastname: Liu
authors.forename: Chen
authors.initials: C
authors.lastname: Zhang
authors.forename: Yi-Yue
authors.initials: YY
authors.lastname: Gui
authors.forename: Yan-Biao
authors.initials: YB
authors.lastname: Liao
authors.forename: Mao
authors.initials: M
authors.lastname: Chen
authors.forename: Ye
authors.initials: Y
authors.lastname: Zhu
mesh_terms: D000789:Angina, Unstable / Q000150:complications; D016022:Case-Control Studies; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D003643:Death; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D064887:Observational Studies as Topic; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed