SynthesisOpen heart2024
Long-term outcomes of ischaemia with no obstructive coronary artery disease (INOCA): a systematic review and meta-analysis.
Synthesis in Open heart, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
14 citing papers in PubMed.
- Women's IschemiA TRial to Reduce Events In Non-ObstRuctive CAD (WARRIOR): a randomised controlled trial.Open heart · 2026Trial
- A Patient and Physician Perspective of Chronic Coronary Syndrome and Persistent Stable Angina in Brazil.Cardiology and therapy · 2026Review
- Article
- Early quantitative stress-perfusion cardiac magnetic resonance reveals perfusion abnormalities consistent with coronary microvascular dysfunction in MINOCA patients with otherwise normal cardiac magnetic resonance findings.Scientific reports · 2026Article
- Early diastolic dysfunction in patients with ischemia and no obstructive coronary artery disease: a prospective study on hybrid positron emission tomography-magnetic resonance imaging.Quantitative imaging in medicine and surgery · 2026Article
- Review
- Analysis of Risk Factors and Development of a Diagnostic Model for Ischemia in Patients With Nonobstructive Coronary Artery Disease Based on Positron Emission Tomography/Computed Tomography.Reviews in cardiovascular medicine · 2026Article
- Endothelial Mitochondrial Dysfunction in INOCA and Coronary Microvascular Dysfunction: Mechanisms, Sex Differences, and Therapeutic Implications.Journal of cardiovascular development and disease · 2026Review
- The Contemporary Role of Intracoronary Physiological Assessment: Fractional Flow Reserve, Non-Hyperemic Pressure Ratios, Wireless Technologies, and Microcirculation.Journal of cardiovascular development and disease · 2026Review
- Feasibility and Impact of Invasive Coronary Function Testing in Ischemia and No Obstructive Coronary Arteries: A Single-Center Study.Journal of the Society for Cardiovascular Angiography & Interventions · 2026Article
- Efficacy and safety of acupuncture for coronary microvascular disease: study protocol for a pilot randomized controlled trial.Frontiers in cardiovascular medicine · 2026Article
- Barriers and facilitators to the uptake of the Ischaemia with Non-Obstructive Coronary Arteries (INOCA) recommendation by cardiologists in the Netherlands: A qualitative study.International journal of cardiology. Cardiovascular risk and prevention · 2025Article
- Invasive Endotyping of Angina Pectoris with Nonobstructive Coronary Arteries.The International journal of angiology : official publication of the International College of Angiology, Inc · 2025Review
- Ischemia with Non-Obstructive Coronary Artery Disease: Sex-Based Differences in Pathophysiology, Clinical Presentation, and Prognosis.Journal of clinical medicine · 2025Review
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Authors and funding
11 authors.
Funding
Abstract
backgroundThe prognosis of myocardial ischaemia with no obstructive coronary artery disease (INOCA) and its underlying vasomotor disorders, vasospastic angina (VSA) and microvascular angina (MVA), is not well defined. The aim of this study was to perform a systematic review and meta-analysis of studies evaluating the long-term prognosis of patients with INOCA.
methodsWe included studies evaluating the prognosis of patients with INOCA published between January 1984 and August 2023 in Medline, Embase, Web of Science and Cochrane databases. Studies were selected if they included patients who fulfilled the Coronary Vasomotor Disorders International Study Group (COVADIS) criteria for either possible or definitive VSA or MVA. The primary outcomes were composite of all-cause death and myocardial infarction (MI), and major adverse cardiovascular event (MACE) at annual intervals up to 5-year follow-up. The incidence of primary outcomes for INOCA, each INOCA endotype and by method used to determine the diagnosis was calculated using the random effects model.
resultsFifty-four studies (17 302 patients) meeting the eligibility criteria were selected. The rate of all-cause death and MI with VSA was 0.7 (95% CI 0.4 to 1.0)/100 patient-years and with MVA was 1.1 (95% CI 0.7 to 1.5)/100 patient-years (p>0.05). The rate of MACE with VSA was 1.1 (95% CI 0.5 to 1.9)/100 patient-years and with MVA was 2.5 (95% CI 1.6 to 3.6)/100 patient-years (p=0.025). Patients with reduced coronary flow reserve (CFR) had higher all-cause death and MI rates than patients whose diagnosis of MVA was established based on an abnormal exercise or imaging stress test (4.7 (95% CI 2.0 to 8.4) vs 0.5 (95% CI 0.1 to 1.1) vs 1.1 (95% CI 0.5 to 2.0)/100 patient-years, p=0.001).
conclusionsOverall, patients with INOCA have a low rate of MACEs, but patients with MVA, especially those with reduced CFR, have a significantly higher rate of MACE than other subgroups, although there is high heterogeneity among the included studies. PROSPERO REGISTRATION NUMBER: CRD42021275070.
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