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

Hiroaki Shimokawa, Akira Suda, Jun Takahashi, Colin Berry, Paolo G. Camici, Filippo Crea, Javier Escaned, Tom Ford, Eric Yii, Juan Carlos Kaski, Takahiko Kiyooka, Puja K. Mehta, Peter Ong, Yukio Ozaki, Carl Pepine, Ornella Rimoldi, Basmah Safdar, Udo Sechtem, Kenichi Tsujita, Satoshi YasudaJohn F. Beltrame, C. Noel Bairey Merz

Research output: Contribution to journalArticlepeer-review

31 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)4592-4600
Number of pages9
JournalEuropean heart journal
Volume42
Issue number44
DOIs
Publication statusPublished - 21-11-2021

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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