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Review
. 2018 Sep 4;7(17):e008868.
doi: 10.1161/JAHA.118.008868.

Ischemia and No Obstructive Coronary Artery Disease ( INOCA ): What Is the Risk?

Romana Herscovici  1 , Tara Sedlak  2 , Janet Wei  1 , Carl J Pepine  3 , Eileen Handberg  3 , C Noel Bairey Merz  1
Affiliations
Review

Ischemia and No Obstructive Coronary Artery Disease ( INOCA ): What Is the Risk?

Romana Herscovici et al. J Am Heart Assoc. .
No abstract available

Keywords: ischemic heart disease; microvascular dysfunction; risk scores.

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Figures

Figure 1
Figure 1
Annual MACE rate stratified by normal coronary arteries, nonobstructive CAD, and obstructive CAD. Annual MACE rates from the reported mean MACE rate divided by the mean years of follow‐up. CAD indicates coronary artery disease; MACE, major adverse cardiovascular events; NCA, normal coronary arteries; NOCAD, nonobstructive coronary artery disease. Outcomes include: Sharaf47: cardiovascular death or nonfatal MI; Maddox4: all‐cause mortality or nonfatal MI; Nielsen41: all‐cause death, MI, late coronary revascularization; Kenkre18: cardiac mortality; Kenkre18*, all‐cause death.
Figure 2
Figure 2
Predicted primary and secondary prevention scores risk vs observed 10‐year risk in an example INOCA patient. Model variables used: female, 55 years, hypertension, systolic blood pressure 139 mm Hg on treatment, heart rate 80 bpm, total cholesterol 200 mg/dL (5.17 mmol/L); low‐density lipoprotein 80 mg/dL (2.068 mmol/L), high‐density lipoprotein 60 mg/dL (1.55 mmol/L), high‐sensitivity C‐reactive protein (hs‐CRP) 2 mg/dL, creatinine 0.9 mg/dL (79 μmol/L), white blood cell count 10 K3/mL, hemoglobin 12 g/dL, no family history, height 5′ 67″ (170 cm), weight 158 pounds (72 kg), body mass index 24.9, low‐risk country, chest pain related to physical/mental stress, glomerular filtration rate 60 mL/min per 1.73 m2. Predicted 10‐year Risk: Primary Prevention Risk Scores: ASCVD—risk of cardiovascular death, nonfatal MI, nonfatal stroke; SCORE—risk of fatal cardiovascular disease; Reynolds (RRS)—risk of myocardial infarction, ischemic stroke, coronary revascularization and cardiovascular death; QRISK2—risk of MI or Stroke; FRS CVD—risk of CHD or coronary insufficiency death, MI, or angina; Secondary Prevention Risk Scores: CALIBER—myocardial infarction, cardiovascular death; GCAD—cardiovascular death; PROMISE—myocardial infarction, cardiovascular death; ACTION—myocardial infarction, stroke, all‐cause death; SMART—myocardial infarction, stroke, vascular death; LIPID—myocardial infarction, cardiovascular death; EUROPA—cardiovascular death; TRS2P—myocardial infarction, stroke, cardiovascular death; PREDICT—myocardial infarction, stroke, cardiovascular death. The 10‐year risk was calculated from the reported risk divided by the numbers of follow‐up years and then projected to 10 years. Observed 10‐year Risk: Sharaf—cardiovascular death or MI (median follow‐up of 9.3 years); Kenkre—cardiac mortality (median follow‐up 9.5 years). ACTION indicates A Coronary disease Trial Investigating Outcome with Nifedipine; ASCVD, Atherosclerotic Cardiovascular Disease; CAD, coronary artery disease; CALIBER, Cardiovascular disease research using Linked Bespoke studies and Electronic Health Records; EUROPA, European trial On reduction of cardiac events with Perindopril in stable coronary Artery disease; FRS‐CVD, Framingham Risk Score Cardiovascular Disease; GCAD, Guangdong Coronary Artery Disease Cohort; INOCA, ischemia and no obstructive coronary artery disease; LIPID, Long‐Term Intervention with Pravastatin in Ischemic Disease; NCA, normal coronary arteries; NOCAD, nonobstructive coronary artery disease; PREDICT, Patients with Renal Impairment and Diabetes undergoing Computed Tomography; PROMISE, Prospective Multicenter Imaging Study of Chest Pain; QRISK2, QRESEARCH cardiovascular disease risk score; RRS, Reynolds Risk Score; SMART, Second Manifestation of Arterial Disease; SCORE, Systematic Coronary Risk Evaluation; TRS2P, Thrombolysis In Myocardial Infarction Risk Score for Secondary Prevention.
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References

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