Characteristics and Prognosis of Patients With Microvascular Angina
Quick Takes
- Microvascular angina occurs in both men and women, but women have more symptoms and lower quality of life.
- Microvascular angina is an important health problem associated with adverse cardiac events. The prognosis is worse in patients with hypertension and previous history of coronary artery disease.
Study Questions:
What are the characteristics and prognosis of patients with microvascular angina?
Methods:
The Coronary Vasomotor Disorders International Study (COVADIS) Group proposed the diagnosis of microvascular angina based on the following criteria: symptoms without obstructive coronary artery disease (CAD) with evidence of myocardial ischemia and impaired coronary microvascular function (i.e., reduced coronary flow reserve, microvascular spasm, increased microvascular resistance, and/or coronary “slow-flow phenomenon”). This prospective observational cohort study enrolled patients from 14 medical centers in seven countries. The primary endpoint was the composite of major adverse cardiovascular events (MACE) (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, hospitalization due to heart failure, or unstable angina).
Results:
Of 686 patients with microvascular angina, 64% were female, 61% were Caucasians, and 29% were Asians. A total of 78 MACE occurred (8.6% in women vs. 6.4% in men, p = 0.19) during median follow-up of 398 days. By multivariable Cox proportional hazard analysis, independent predictors of MACE were hypertension and prior history of CAD. Women had worse Seattle Angina Questionnaire scores than men (p < 0.05), but there were no differences in prognosis by sex or ethnicity.
Conclusions:
Microvascular angina portends a substantial risk for MACE, with higher risks in the setting of hypertension and prior CAD. Microvascular angina is an important problem regardless of sex or ethnicity; however, women have more symptoms and a lower quality of life.
Perspective:
This large international observational study used specific diagnostic criteria for inclusion of patients with microvascular angina. Consistent with prior studies, microvascular angina occurred more often in women but there were no sex-related differences in prognosis. Women had lower quality of life due to worse symptoms of angina. It is postulated that female hormones contribute to the perception of chest pain in patients with microvascular angina, but more research is needed. Two studies are underway to assess the optimal treatment of microvascular angina: WARRIOR (Women’s IschemiA Trial to Reduce Events In Non-ObstRuctive CAD) and iCorMicA (International Coronary Microvascular Angina Trial).
Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Stable Ischemic Heart Disease, Atherosclerotic Disease (CAD/PAD), Acute Heart Failure, Hypertension, Chronic Angina
Keywords: Angina, Unstable, Chest Pain, Coronary Artery Disease, Ethnic Groups, Heart Failure, Hypertension, Ischemia, Microvascular Angina, Myocardial Infarction, Myocardial Ischemia, No-Reflow Phenomenon, Quality of Life, Secondary Prevention, Spasm, Stroke, Women
< Back to Listings