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Heart (British Cardiac Society) Mar 2020
Review
Topics: Angina Pectoris; Humans; Practice Guidelines as Topic
PubMed: 32054665
DOI: 10.1136/heartjnl-2018-314661 -
JACC. Cardiovascular Interventions Jan 2020The aim of this study was to test the hypothesis that invasive coronary function testing at time of angiography could help stratify management of angina patients without... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
The aim of this study was to test the hypothesis that invasive coronary function testing at time of angiography could help stratify management of angina patients without obstructive coronary artery disease.
BACKGROUND
Medical therapy for angina guided by invasive coronary vascular function testing holds promise, but the longer-term effects on quality of life and clinical events are unknown among patients without obstructive disease.
METHODS
A total of 151 patients with angina with symptoms and/or signs of ischemia and no obstructive coronary artery disease were randomized to stratified medical therapy guided by an interventional diagnostic procedure versus standard care (control group with blinded interventional diagnostic procedure results). The interventional diagnostic procedure-facilitated diagnosis (microvascular angina, vasospastic angina, both, or neither) was linked to guideline-based management. Pre-specified endpoints included 1-year patient-reported outcome measures (Seattle Angina Questionnaire, quality of life [EQ-5D]) and major adverse cardiac events (all-cause mortality, myocardial infarction, unstable angina hospitalization or revascularization, heart failure hospitalization, and cerebrovascular event) at subsequent follow-up.
RESULTS
Between November 2016 and December 2017, 151 patients with ischemia and no obstructive coronary artery disease were randomized (n = 75 to the intervention group, n = 76 to the control group). At 1 year, overall angina (Seattle Angina Questionnaire summary score) improved in the intervention group by 27% (difference 13.6 units; 95% confidence interval: 7.3 to 19.9; p < 0.001). Quality of life (EQ-5D index) improved in the intervention group relative to the control group (mean difference 0.11 units [18%]; 95% confidence interval: 0.03 to 0.19; p = 0.010). After a median follow-up duration of 19 months (interquartile range: 16 to 22 months), major adverse cardiac events were similar between the groups, occurring in 9 subjects (12%) in the intervention group and 8 (11%) in the control group (p = 0.803).
CONCLUSIONS
Stratified medical therapy in patients with ischemia and no obstructive coronary artery disease leads to marked and sustained angina improvement and better quality of life at 1 year following invasive coronary angiography. (Coronary Microvascular Angina [CorMicA]; NCT03193294).
Topics: Aged; Angina Pectoris; Cardiac Catheterization; Cardiovascular Agents; Cause of Death; Clinical Decision-Making; Coronary Angiography; Disease Progression; Female; Fractional Flow Reserve, Myocardial; Humans; Male; Middle Aged; Patient Satisfaction; Predictive Value of Tests; Quality of Life; Recovery of Function; Scotland; Severity of Illness Index; Time Factors; Treatment Outcome
PubMed: 31709984
DOI: 10.1016/j.jcin.2019.11.001 -
The New England Journal of Medicine Apr 2022In the diagnosis of obstructive coronary artery disease (CAD), computed tomography (CT) is an accurate, noninvasive alternative to invasive coronary angiography (ICA).... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
In the diagnosis of obstructive coronary artery disease (CAD), computed tomography (CT) is an accurate, noninvasive alternative to invasive coronary angiography (ICA). However, the comparative effectiveness of CT and ICA in the management of CAD to reduce the frequency of major adverse cardiovascular events is uncertain.
METHODS
We conducted a pragmatic, randomized trial comparing CT with ICA as initial diagnostic imaging strategies for guiding the treatment of patients with stable chest pain who had an intermediate pretest probability of obstructive CAD and were referred for ICA at one of 26 European centers. The primary outcome was major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) over 3.5 years. Key secondary outcomes were procedure-related complications and angina pectoris.
RESULTS
Among 3561 patients (56.2% of whom were women), follow-up was complete for 3523 (98.9%). Major adverse cardiovascular events occurred in 38 of 1808 patients (2.1%) in the CT group and in 52 of 1753 (3.0%) in the ICA group (hazard ratio, 0.70; 95% confidence interval [CI], 0.46 to 1.07; P = 0.10). Major procedure-related complications occurred in 9 patients (0.5%) in the CT group and in 33 (1.9%) in the ICA group (hazard ratio, 0.26; 95% CI, 0.13 to 0.55). Angina during the final 4 weeks of follow-up was reported in 8.8% of the patients in the CT group and in 7.5% of those in the ICA group (odds ratio, 1.17; 95% CI, 0.92 to 1.48).
CONCLUSIONS
Among patients referred for ICA because of stable chest pain and intermediate pretest probability of CAD, the risk of major adverse cardiovascular events was similar in the CT group and the ICA group. The frequency of major procedure-related complications was lower with an initial CT strategy. (Funded by the European Union Seventh Framework Program and others; DISCHARGE ClinicalTrials.gov number, NCT02400229.).
Topics: Angina Pectoris; Chest Pain; Coronary Angiography; Coronary Artery Disease; Female; Humans; Male; Tomography, X-Ray Computed
PubMed: 35240010
DOI: 10.1056/NEJMoa2200963 -
BMJ Open Jul 2023Evidence on the association of oxidative balance score (OBS) and visceral adiposity index (VAI) with risk of ischaemic heart disease (IHD) is limited. We aimed to...
OBJECTIVE
Evidence on the association of oxidative balance score (OBS) and visceral adiposity index (VAI) with risk of ischaemic heart disease (IHD) is limited. We aimed to explore the association of OBS and VAI with risk of IHD, and then examined their potential interactive effects.
DESIGN
A cross-sectional study.
SETTING
The National Health and Nutrition Examination Survey.
PARTICIPANTS
A total of 27 867 individuals aged more than 20 years were included in this study.
PRIMARY AND SECONDARY OUTCOME MEASURES
Multivariable logistic regression analyses were used to estimate ORs and 95% CIs for the associations of OBS and VAI with risk of IHD, including coronary heart disease (CHD), heart attack and angina pectoris.
RESULTS
Compared with those in the first quintile, participants with highest quintile of OBS had decreased risk of IHD (OR: 0.59, 95% CI: 0.50, 0.69), CHD (OR: 0.65, 95% CI: 0.52, 0.80), heart attack (OR: 0.53, 95% CI: 0.43, 0.66) and angina pectoris (OR: 0.63, 95% CI: 0.48, 0.82); meanwhile, those with highest quintile of VAI had increased risk of IHD (OR: 1.46, 95% CI: 1.22, 1.74), CHD (OR: 1.34, 95% CI: 1.07, 1.67), heart attack (OR: 1.55, 95% CI: 1.24, 1.94) and angina pectoris (OR: 1.40, 95% CI: 1.04, 1.87). Furthermore, we observed a stronger association between OBS and risk of IHD among participants with VAI ≥1.73 (OR: 0.50, 95% CI: 0.40, 0.62).
CONCLUSION
Our study found the negative association between OBS and risk of IHD, and positive association between VAI and risk of IHD. In addition, we found the interactive effects between VAI and OBS on the risk of IHD, underlining the importance of OBS in IHD prevention among participants with high VAI level.
Topics: Humans; Risk Factors; Cross-Sectional Studies; Nutrition Surveys; Adiposity; Intra-Abdominal Fat; Coronary Disease; Angina Pectoris; Myocardial Infarction; Obesity, Abdominal; Oxidative Stress
PubMed: 37451720
DOI: 10.1136/bmjopen-2023-072334 -
Circulation Journal : Official Journal... May 2023
Topics: Humans; Coronary Vasospasm; Muscle Spasticity; Angina Pectoris, Variant; Angina Pectoris; Myocardial Ischemia; Coronary Angiography
PubMed: 36908169
DOI: 10.1253/circj.CJ-22-0779 -
Interventional Cardiology Clinics Jul 2022Refractory angina (RA) is defined as chest pain caused by coronary ischemia in patients on maximal medical therapy and is not amenable to revascularization despite... (Review)
Review
Refractory angina (RA) is defined as chest pain caused by coronary ischemia in patients on maximal medical therapy and is not amenable to revascularization despite advanced coronary artery disease (CAD). The long-term prognosis has improved with optimal medical therapy including risk factor modification. Still, patients are left with major impairment in quality of life and have high resource utilization with limited treatment options. We review the novel invasive and noninvasive therapies under investigation for RA.
Topics: Angina Pectoris; Coronary Artery Disease; Humans; Myocardial Ischemia; Quality of Life; Risk Factors
PubMed: 35710283
DOI: 10.1016/j.iccl.2022.03.002 -
Journal of the American College of... Jul 2023The impact of complete revascularization (CR) on angina-related health status (symptoms, function, quality of life) in chronic coronary disease (CCD) has not been well... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The impact of complete revascularization (CR) on angina-related health status (symptoms, function, quality of life) in chronic coronary disease (CCD) has not been well studied.
OBJECTIVES
Among patients with CCD randomized to invasive (INV) vs conservative (CON) management in ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches), we compared the following: 1) the impact of anatomic and functional CR on health status compared with incomplete revascularization (ICR); and 2) the predicted impact of achieving CR in all INV patients compared with CON.
METHODS
Multivariable regression adjusting for patient characteristics was used to compare 12-month health status after independent core laboratory-defined CR vs ICR in INV patients who underwent revascularization. Propensity-weighted modeling was then performed to estimate the treatment effect had CR or ICR been achieved in all INV patients, compared with CON.
RESULTS
Anatomic and functional CR were achieved in 43.3% and 57.8% of 1,641 INV patients, respectively. Among revascularized patients, CR was associated with improved Seattle Angina Questionnaire Angina Frequency compared with ICR after adjustment for baseline differences. After modeling CR and ICR in all INV patients, patients with CR and ICR each had greater improvements in health status than CON, with better health status with CR than ICR. The projected benefits of CR were most pronounced in patients with baseline daily/weekly angina and not seen in those with no angina.
CONCLUSIONS
Among patients with CCD in ISCHEMIA, health status improved more with CR compared with ICR or CON, particularly in those with frequent angina. Anatomic and functional CR provided comparable improvements in quality of life. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522).
Topics: Humans; Quality of Life; Treatment Outcome; Angina Pectoris; Health Status; Myocardial Revascularization; Ischemia; Coronary Artery Disease
PubMed: 37468185
DOI: 10.1016/j.jacc.2023.05.025 -
Aging Sep 2023Observational studies suggest that cardiovascular disease (CVD) increases the risk of developing Alzheimer's disease (AD). However, the causal relationship between the...
Observational studies suggest that cardiovascular disease (CVD) increases the risk of developing Alzheimer's disease (AD). However, the causal relationship between the two is not clear. This study applied a two-sample bidirectional Mendelian randomization method to explore the causal relationship between CVD and AD. Genome-wide association study (GWAS) data from 46 datasets of European populations (21,982 cases of AD and 41,944 controls) were utilized to obtain genetic instrumental variables for AD. In addition, genetic instrumental variables for atrial fibrillation (AF), heart failure (HF), myocardial infarction (MI), coronary heart disease (CHD), angina pectoris (AP), and ischemic stroke (IS) (including large-artery atherosclerotic stroke [LAS] and cardioembolic stroke [CES]) were selected from GWAS data of European populations ( < 5E-8). The inverse variance weighting method was employed as the major Mendelian randomization analysis method. Genetically predicted AD odds ratios (OR) (1.06) (95% CI: 1.02-1.10, = 0.003) were linked to higher AP analysis. A higher genetically predicted OR for CES (0.9) (95% CI 0.82-0.99, = 0.02) was linked to a decreased AD risk. This Mendelian randomized study identified AD as a risk factor for AP. In addition, CES was related to a reduced incidence of AD. Therefore, these modifiable risk factors are crucial targets for preventing and treating AD.
Topics: Humans; Cardiovascular Diseases; Mendelian Randomization Analysis; Alzheimer Disease; Genome-Wide Association Study; Causality; Angina Pectoris
PubMed: 37665672
DOI: 10.18632/aging.205013 -
Pharmacology & Therapeutics Sep 2023Vasospastic angina (VSA) is characterized by episodes of rest angina that are responsive to short-acting nitrates and are attributable to coronary artery vasospasm. The... (Review)
Review
Vasospastic angina (VSA) is characterized by episodes of rest angina that are responsive to short-acting nitrates and are attributable to coronary artery vasospasm. The condition is underdiagnosed as the provocation test is rarely performed. VSA, the most important component of non-obstructive coronary artery disease, can present with angina, be asymptomatic, or can even present with fatal arrhythmias and cardiac arrest. Although most patients with VSA respond well to vasodilating medications, prognosis does not improve as expected in most patients, suggesting the existence elusive prognostic factors and pathogenesis that warrant further exploration. Moreover, patients with either severe or refractory VSA barely respond to conventional treatment and may develop life-threatening arrhythmias or suffer sudden cardiac death during ischemic attacks, which are associated with immune-inflammatory responses and have been shown to achieve remission following glucocorticoid and immunoglobulin treatments. Our recent work revealed that inflammation plays a key role in the initiation and development of coronary spasms, and that inflammatory cytokines have predictive value for diagnosis. In contrast to the existing literature, this review both summarizes the theoretical and clinical aspects of VSA, and also discusses the relationship between inflammation, especially myocarditis and VSA, in order to provide novel insights into the etiology, diagnosis, and treatment of VSA.
Topics: Humans; Coronary Vasospasm; Angina Pectoris; Coronary Artery Disease; Prognosis; Arrhythmias, Cardiac; Inflammation
PubMed: 37482097
DOI: 10.1016/j.pharmthera.2023.108500 -
Ugeskrift For Laeger Sep 2020Cardiac CT has become a frequently used diagnostic modality in Denmark, especially for the evaluation of coronary artery disease indicated by angina pectoris/dyspnoea.... (Review)
Review
Cardiac CT has become a frequently used diagnostic modality in Denmark, especially for the evaluation of coronary artery disease indicated by angina pectoris/dyspnoea. Indications have recently expanded to include evaluation of valvular heart disease, pre- and post-procedural evaluation related to several invasive procedures as well as some congenital and pediatric cardiac conditions. As described in this review, improved image quality and reduced radiation, owing to technological advances as well as a high number of well-performed scientific studies, have paved the way for this development.
Topics: Angina Pectoris; Child; Coronary Angiography; Coronary Artery Disease; Heart; Humans; Tomography, X-Ray Computed
PubMed: 33000733
DOI: No ID Found