Patients With Non-Obstructive Coronary Artery Disease and Polyvascular Disease. Sub-Analysis of the Real-World Registry KAMMA (Clinical Registry on Patient Population With Polyvascular Disease in the Russian Federation and Eurasian Countries)
https://doi.org/10.18087/cardio.2024.8.n2683
Abstract
Aim. To study the clinical status and data of laboratory and instrumental examination of patients with non-obstructive ischemic heart disease (IHD) and multifocal atherosclerosis (MFA) included in the KAMMA registry.
Material and methods. The subanalysis included 1,893 IHD patients who underwent coronary angiography (CAG) and ultrasonic examination of peripheral arteries. Based on the CAG data, patients were divided into two groups: group 1, patients with obstructive coronary atherosclerosis (CA) (maximum stenosis ≥50% and/or history of percutaneous coronary intervention/coronary artery bypass grafting, n=1728; 91.3%) and group 2, patients with non-obstructive CA (maximum stenosis <50%, n = 165; 8.7%).
Results. A comparative analysis based on the degree of coronary obstruction in patients with verified IHD who were included in the KAMMA registry showed that 8.7% of them had coronary artery stenosis of less than 50%. The overwhelming majority of patients with non-obstructive CA had MFA affecting the brachiocephalic arteries in 94.3% and the lower extremity arteries in 40.2%. Among patients with non-obstructive IHD, women predominated; risk factors such as smoking and type 2 diabetes mellitus were less frequent in this group than in the obstructive IHD group. Patients with non-obstructive CA more frequently had a history of dyslipidemia; they had higher total cholesterol and non-high-density lipoprotein cholesterol; and they more frequently received moderate-intensity statin therapy than patients with obstructive CA (55.8% vs. 34.5%). Characteristic features of patients with non-obstructive CA were less severe IHD and less frequent history of acute coronary syndrome. However, the incidence of stroke, peripheral arterial thrombosis, and chronic arterial insufficiency of the lower extremities did not differ in groups 1 and 2, whereas the incidence of paroxysmal atrial fibrillation was higher in the non-obstructive IHD group.
Conclusion. IHD patients without coronary obstruction also require assessment of the peripheral arterial status, as they may have advanced MFA, which should be taken into account when choosing the “aggressiveness” of therapy.
Keywords
About the Authors
G. P. ArutyunovRussian Federation
MD, PhD, professor, corresponding member of the Russian academy of sciences, President of the Association “Eurasian Association of Internal Medicine”, head of the department of propaedeutics of internal diseases (pediatric school) Pirogov Russian national research medical university, honored doctor of the Russian Federation
E. I. Tarlovskaya
Russian Federation
MD, PhD, professor, Chairperson of the Association "Eurasian Association of Internal Medicine", head of the department of therapy and cardiology, Privolzhsky research medical university
A. G. Arutyunov
Armenia
MD, PhD, member of the board of the Association “Eurasian Association of Internal Medicine”, FEFIM, FESC, professor at national institute of health named after S. Avdalbekyan, honorary professor of the national medical university of Kazakhstan
T. I. Batluk
Russian Federation
PhD., senior medical advisor Association “Eurasian Association of Internal Medicine”
N. A. Koziolova
Russian Federation
MD, PhD, professor, head of the department of propaedeutics of internal diseases No.2 Perm State Medical University ak. E.A. Wagner, member of the Presidium of the Board of RKO, member of the Board of OSSN, member of the Board of the NOA, member of the Board of the Association “Eurasian Association of Internal Medicine”
A. I. Chesnikova
Russian Federation
MD, PhD, professor, professor in the department of internal medicine No.1 Rostov State Medical University
A. Yu. Vaskin
Russian Federation
Project Manager Association "Eurasian Association of Internal Medicine"
D. S. Tokmin
Russian Federation
head of "Alphastat" analytic agency
I. G. Bakulin
Russian Federation
MD, PhD, professor, head of the chair of the propedeutics of internal diseases, gastroenterology and dietology n.a. S.M. Riss «Mechnikov North-Western State Medical University»
O. L. Barbarash
Russian Federation
RAS Academician, professor, MD, PhD, head of institute Scientific research institute for complex issues of cardiovascular disease
N. Yu. Grigoryeva
Russian Federation
MD, PhD, associate professor, head of the department of clinical medicine of the National Research Lobachevsky State University of Nizhni Novgorod
I. V. Gubareva
Russian Federation
MD, PhD, Associated professor, head of the department of internal diseases Samara State Medical University
N. V. Izmozherova
Russian Federation
MD, PhD, Docent, head of department of pharmacology and clinical pharmacology, Ural State Medical University Healthcare Ministry of Russia
U. K. Kamilova
Uzbekistan
MD, PhD, professor, deputy director for research SI "Republican specialized scientific and practical medical center of therapy and medical rehabilitation"
S. G. Kechedzhieva
Russian Federation
PhD, associate professor, head of the department of geriatrics, medical and social expertise with a course of general medical practice Stavropol State Medical University
Z. F. Kim
Russian Federation
PhD, deputy head physician on medical affairs of City clinical hospital No. 7; Chief freelance cardiologist of the Ministry of health of Republic of Tatarstan
N. A. Koriagina
Russian Federation
chief physician of Women's health clinic LLC, MD, PhD
S. V. Mironova
Russian Federation
PhD, associated professor, cardiologist SBHI PR Perm regional hospital for veteran’s war
N. P. Mitkovskaya
Belarus
MD, PhD, professor, director of the Republican scientific and practical center of cardiology
S. V. Nemirova
Russian Federation
PhD, associate professor of B.A. Korolev department of hospital surgery Privolzhsky research medical university of the Ministry of Health of the Russian Federation
L. M. Nurieva
Russian Federation
cardiologist of the cardiology department No. 1 of City clinical hospital No. 7
M. M. Petrova
Russian Federation
MD, PhD, professor V.F.Voino - Yasenetsky Krasnoyarsk State Medical University
E. A. Polyanskaya
Russian Federation
PhD, assistant professor of the department of propaedeutic of internal diseases №2 Perm State Medical University ak. E.A. Wagner, cardiologist
A. P. Rebrov
Russian Federation
MD, PhD, professor, head of hospital therapy department of Federal State educational institution of high education “Saratov State Medical University n.a. V.I. Razumovsky” Ministry of Health Russian Federation
A. V. Svarovskaya
Russian Federation
MD, PhD, senior researcher, department of myocardial pathology Cardiology research institute, Tomsk national research medical center Russian Academy of Sciences
E. A. Smirnova
Russian Federation
MD, PhD, associate professor, head of the department of internal diseases Ryazan State Medical University
A. B. Sugraliev
Kazakhstan
PhD., head of the department of internal medicine Asfendiyarov Kazakh national medical university
Ya. B. Khovaeva
Russian Federation
professor, head of therapy and family medicine department, Perm State Medical University
G. V. Shavkuta
Russian Federation
MD, PhD, professor, head of the department of general medical practice (family medicine) with courses in geriatrics and physiotherapy) Rostov-on-Don State Medical University
I. I. Shaposhnik
Russian Federation
head of the department of propaedeutics of internal diseases, MD, PhD, professor Federal State Budgetary Educational Institution of Higher Education "South Ural State Medical University " of the Ministry of Health of the Russian Federation
M. Yu.K. Alieva
Uzbekistan
junior researcher SI "Republican specialized scientific and practical medical center of therapy and medical rehabilitation"
A. B. Almukhanova
Kazakhstan
PhD., associate professor of the department of internal medicine Asfendiyarov Kazakh national medical university
A. V. Aparkina
Russian Federation
PhD, associate professor, department of hospital therapy of general medicine faculty, State Educational Institution of Higher Professional Education «Saratov State Medical University n.a. V.I. Razumovskiy»
R. A. Bashkinov
Russian Federation
medical advisor, rheumatologist, postgraduate of the "Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E. E. Eichwald" "North-Western State Medical University named after I.I. Mechnikov"
L. N. Belousova
Russian Federation
PhD, assistant professor of the chair of the propaedeutics of internal diseases, gastroenterology and dietology n.a. S.M. Riss «North-Western State Medical University after I.I. Mechnicov»
E. I. Blokhina
Russian Federation
cardiologist, assistant of the Department of clinical medicine of the National research Lobachevsky State University of Nizhny Novgorod
V. O. Bochkareva
Russian Federation
pulmonologist Regional State budgetary healthcare institution «Krasnoyarsk interdistrict clinical emergency hospital named after N.S. Karpovich»
M. V. Buianova
Russian Federation
PhD., therapist, cardiologist, assistant of the department of clinical medicine of the National Research Lobachevsky State University of Nizhny Novgorod
F. Yu. Valikulova
Russian Federation
PhD, associate professor of therapy and cardiology department, vice dean of the faculty of network educational programs, cardiologist of the highest certification category Federal State Budgetary Educational Institution of Higher Education «Privolzhsky research medical university» of the Ministry of Health Care of the Russian Federation
A. D. Vende
Russian Federation
student Federal state-funded educational institution of higher education “Siberian State Medical University” of the Ministry of Healthcare of the Russian Federation
A. S. Galyavich
Russian Federation
MD, PhD, professor, the head of the Department of cardiology of Kazan State Medical University; Chief freelance cardiologist of the Ministry of Health of the Russian Federation in the Volga Federal District
V. V. Genkel
Russian Federation
PhD, associated professor at the department of propaedeutics of internal medicine Federal State Budgetary Educational Institution of Higher Education "South Ural State Medical University " of the Ministry of Health of the Russian Federation
E. V. Gorbunova
Russian Federation
MD, PhD, leading researcher head of outpatient department Kuzbass clinical cardiology dispensary named after academician L.S. Barbarash
E. D. Gordeychuk
Russian Federation
medical advisor, pediatric cardiology resident, Pirogov russian national research medical university
E. A. Grigorenko
Belarus
deputy director for international partnership and analytical work SI "Republican scientific and practical center of cardiology" of the Ministry of Health of the Republic of Belarus
E. V. Grigoryeva
Russian Federation
PhD, assistant of professor of hospital therapy department of Federal State Educational Institution of High Education “Saratov State Medical University n.a. V.I. Razumovsky” Ministry of Health Russian Federation
I. L. Davydkin
Russian Federation
MD, PhD, professor, head of the hospital therapy department Samara State Medical University
D. S. Evdokimov
Russian Federation
assistant of the department of faculty therapy of the North-Western State Medical University named after I.I. Mechnikov
A. N. Ermilova
Russian Federation
psychiatrist, psychotherapist, senior medical advisor Association "Eurasian Association of Internal Medicine"
Sh. B. Zhangelova
Kazakhstan
professor of the department of internal diseases, PhD., associate professor Asfendiyarov Kazakh national medical university
N. V. Zhdankina
Russian Federation
PhD., associate professor of the department of clinical medicine National Research Lobachevsky State University of Nizhny Novgorod
E. I. Zheleznyak
Russian Federation
PhD, assistant department of internal medicine N2 Federal State Budgetary Educational Institution of Higher Education «Rostov State Medical University»
N. S. Ilyanok
Russian Federation
resident of the department of internal diseases, therapist, general practitioner Ryazan State Medical University
D. A. Kapsultanova
Kazakhstan
PhD., associate professor of the department of internal medicine Asfendiyarov Kazakh national medical university
N. A. Karoli
Russian Federation
MD, PhD, professor of hospital therapy chair of general medicine department, V. I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of the Russia
E. A. Kartashova
Russian Federation
PhD, assistant professor, department of Internal medicine N2, Federal State Budgetary Educational Institution of Higher Education «Rostov State Medical University»
A. S. Kuznetsova
Russian Federation
PhD, associate professor of the department of clinical therapy Federal State Budgetary Educational Institution of Higher Education "South Ural State Medical University" of the Ministry of Health of the Russian Federation
A. T. Kumaritova
Russian Federation
resident of the chair of the propedeutics of internal diseases, gastroenterology and dietology n.a. S.M. Riss «Mechnikov North-Western State Medical University»
N. A. Magdeeva
Russian Federation
PhD, assistant of professor of hospital therapy department of Federal State Educational Institution of High Education “Saratov State Medical University n.a. V.I. Razumovsky” Ministry of Health Russian Federation
S. A. Makarov
Russian Federation
MD, PhD, head of laboratory for modeling management technologies, head Dr Scientific Research Institute for Complex issues of cardiovascular disease
E. S. Melnikov
Russian Federation
medical adviser, rheumatologist, postgraduate student of the "Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E. E. Eichwald" "North-Western State Medical University named after I.I. Mechnikov"
M. V. Novikova
Russian Federation
PhD., cardiologist Stavropol regional cardiology centre
I. A. Obukhova
Russian Federation
pulmonologist Regional State Budgetary Healthcare Institution "Krasnoyarsk interdistrict clinical emergency hospital named after N.S. Karpovich
E. V. Ponomarenko
Russian Federation
cardiologist "Health formula LLС"
A. O. Rubanenko
Russian Federation
PhD, associate professor of the propaedeutic therapy department Samara State Medical University
O. A. Rubanenko
Russian Federation
MD, PhD, associate professor of the hospital therapy department Samara State Medical University
F. E. Rustamova
Kazakhstan
PhD., associate professor of the department of internal medicine Asfendiyarov Kazakh National medical university
V. A. Safronenko
Russian Federation
PhD, associate professor of the department of internal diseases No. 1, Rostov State Medical University
E. I. Suchkova
Russian Federation
PhD., assistant of the department of internal diseases Ryazan State Medical University
A. I. Sycheva
Russian Federation
postgraduate student of therapy and family medicine department, Perm State Medical University
D. R. Tagaeva
Uzbekistan
junior researcher Republican specialized scientific and practical medical center of therapy and medical rehabilitation
M. A. Trubnikova
Russian Federation
nephrologist, medical advisor, Association "Eurasian Association of Internal Medicine"
T. P. Trunina
Russian Federation
PhD, associate professor of the department of internal diseases Ryazan State Medical University
A. G. Frolov
Russian Federation
doctor Hospital №5
V. V. Khatlamadzhiyan
Russian Federation
6th year student of the faculty of medicine and prevention, laboratory assistant of the department of internal diseases No. 1 Rostov State Medical University
Yu. I. Khokhlova
Russian Federation
resident of the chair of the propedeutics of internal diseases, gastroenterology and dietology n.a. S.M. Riss «Mechnikov North-Western State Medical University»
A. I. Chernyavina
Russian Federation
PhD, cardiologist, associated professor SBHI PR Perm regional hospital for veterans war
O. Yu. Chizhova
Russian Federation
MD, PhD, professor of the chair of the propaedeutics of internal diseases, gastroenterology and dietology n.a. S.M. Riss «Mechnikov North-Western State Medical University»
M. A. o. Shambatov
Russian Federation
therapist, postgraduate student, Ural State Medical University, Healthcare Ministry of Russia
T. V. Shnyukova
Russian Federation
PhD, assistant professor of the department of general medical practice (family medicine) (with courses in geriatrics and physiotherapy) Rostov-on-Don State Medical University
Yu. V. Shchukin
Russian Federation
MD, PhD, professor of the propaedeutic therapy department Samara State Medical University
References
1. Kunadian V, Chieffo A, Camici PG, Berry C, Escaned J, Maas AHEM et al. An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group. EuroIntervention. 2021;16(13):1049–69. DOI: 10.4244/EIJY20M07_01
2. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal. 2020;41(3):407–77. DOI: 10.1093/eurheartj/ehz425
3. Boden WE, Marzilli M, Crea F, Mancini GBJ, Weintraub WS, Taqueti VR et al. Evolving Management Paradigm for Stable Ischemic Heart Disease Patients. Journal of the American College of Cardiology. 2023;81(5):505–14. DOI: 10.1016/j.jacc.2022.08.814
4. Joodi G, Palimar S, Press MC. Percutaneous Coronary Interventions in Women. Current Atherosclerosis Reports. 2023;25(11):829–37. DOI: 10.1007/s11883-023-01150-x
5. Reynolds HR, Diaz A, Cyr DD, Shaw LJ, Mancini GBJ, Leipsic J et al. Ischemia With Nonobstructive Coronary Arteries. JACC: Cardiovascular Imaging. 2023;16(1):63–74. DOI: 10.1016/j.jcmg.2022.06.015
6. Batluk T.I., Tarlovskaya E.I., Arutyunov G.P., Koziolova N.A., Chesnikova A.I., Barbarash O.L. et al. Clinical registry on patient population with Multifocal Atherosclerosis in the Russian Federation and Eurasian countries – KAMMA. Complex Issues of Cardiovascular Diseases. 2023;12(2):6–13. DOI: 10.17802/2306-1278-2023-12-2-6-13
7. Jenkins K, Pompei G, Ganzorig N, Brown S, Beltrame J, Kunadian V. Vasospastic angina: a review on diagnostic approach and management. Therapeutic Advances in Cardiovascular Disease. 2024;18:17539447241230400. DOI: 10.1177/17539447241230400
8. Sardu C, Trotta MC, Sasso FC, Sacra C, Carpinella G, Mauro C et al. SGLT2-inhibitors effects on the coronary fibrous cap thickness and MACEs in diabetic patients with inducible myocardial ischemia and multi vessels non-obstructive coronary artery stenosis. Cardiovascular Diabetology. 2023;22(1):80. DOI: 10.1186/s12933-023-01814-7
9. Jung J, Lee S-N, Her S-H, Yoo K-D, Moon K-W, Moon D et al. Long-Term Clinical Impact of Patients with Multi-Vessel Non-Obstructive Coronary Artery Disease. Life. 2023;13(11):2119. DOI: 10.3390/life13112119
10. Mehta PK, Huang J, Levit RD, Malas W, Waheed N, Bairey Merz CN. Ischemia and no obstructive coronary arteries (INOCA): A narrative review. Atherosclerosis. 2022;363:8–21. DOI: 10.1016/j.atherosclerosis.2022.11.009
11. Mahajan AM, Gandhi H, Smilowitz NR, Roe MT, Hellkamp AS, Chiswell K et al. Seasonal and circadian patterns of myocardial infarction by coronary artery disease status and sex in the ACTION Registry-GWTG. International Journal of Cardiology. 2019;274:16–20. DOI: 10.1016/j.ijcard.2018.08.103
12. Aziz A, Hansen HS, Sechtem U, Prescott E, Ong P. Sex-Related Differences in Vasomotor Function in Patients With Angina and Unobstructed Coronary Arteries. Journal of the American College of Cardiology. 2017;70(19):2349–58. DOI: 10.1016/j.jacc.2017.09.016
13. Waheed N, Elias-Smale S, Malas W, Maas AH, Sedlak TL, Tremmel J et al. Sex differences in non-obstructive coronary artery disease. Cardiovascular Research. 2020;116(4):829–40. DOI: 10.1093/cvr/cvaa001
14. Zhang H-W, Jin J-L, Cao Y-X, Guo Y-L, Wu N-Q, Zhu C-G et al. Association of diabetes mellitus with clinical outcomes in patients with different coronary artery stenosis. Cardiovascular Diabetology. 2021;20(1):214. DOI: 10.1186/s12933-021-01403-6
15. Wilkinson MJ, Xu I, Vasudevan RS, You H, Xu R, Taub PR. Trends in LDL-C following coronary angiography involving assessment by fractional flow reserve in obstructive vs non-obstructive coronary artery disease. American Journal of Preventive Cardiology. 2023;13:100473. DOI: 10.1016/j.ajpc.2023.100473
16. Mygind ND, Michelsen MM, Pena A, Frestad D, Dose N, Aziz A et al. Coronary Microvascular Function and Cardiovascular Risk Factors in Women With Angina Pectoris and No Obstructive Coronary Artery Disease: The iPOWER Study. Journal of the American Heart Association. 2016;5(3):e003064. DOI: 10.1161/JAHA.115.003064
17. Bainey KR, Welsh RC, Alemayehu W, Westerhout CM, Traboulsi D, Anderson T et al. Population-level incidence and outcomes of myocardial infarction with non-obstructive coronary arteries (MINOCA): Insights from the Alberta contemporary acute coronary syndrome patients invasive treatment strategies (COAPT) study. International Journal of Cardiology. 2018;264:12–7. DOI: 10.1016/j.ijcard.2018.04.004
18. Lopez-Pais J, Izquierdo Coronel B, Galán Gil D, Espinosa Pascual MJ, Alcón Durán B, Martinez Peredo CG et al. Clinical characteristics and prognosis of myocardial infarction with non-obstructive coronary arteries: A prospective single-center study. Cardiology Journal. 2022;29(5):798–806. DOI: 10.5603/CJ.a2020.0146
Review
For citations:
Arutyunov G.P., Tarlovskaya E.I., Arutyunov A.G., Batluk T.I., Koziolova N.A., Chesnikova A.I., Vaskin A.Yu., Tokmin D.S., Bakulin I.G., Barbarash O.L., Grigoryeva N.Yu., Gubareva I.V., Izmozherova N.V., Kamilova U.K., Kechedzhieva S.G., Kim Z.F., Koriagina N.A., Mironova S.V., Mitkovskaya N.P., Nemirova S.V., Nurieva L.M., Petrova M.M., Polyanskaya E.A., Rebrov A.P., Svarovskaya A.V., Smirnova E.A., Sugraliev A.B., Khovaeva Ya.B., Shavkuta G.V., Shaposhnik I.I., Alieva M.Yu., Almukhanova A.B., Aparkina A.V., Bashkinov R.A., Belousova L.N., Blokhina E.I., Bochkareva V.O., Buianova M.V., Valikulova F.Yu., Vende A.D., Galyavich A.S., Genkel V.V., Gorbunova E.V., Gordeychuk E.D., Grigorenko E.A., Grigoryeva E.V., Davydkin I.L., Evdokimov D.S., Ermilova A.N., Zhangelova Sh.B., Zhdankina N.V., Zheleznyak E.I., Ilyanok N.S., Kapsultanova D.A., Karoli N.A., Kartashova E.A., Kuznetsova A.S., Kumaritova A.T., Magdeeva N.A., Makarov S.A., Melnikov E.S., Novikova M.V., Obukhova I.A., Ponomarenko E.V., Rubanenko A.O., Rubanenko O.A., Rustamova F.E., Safronenko V.A., Suchkova E.I., Sycheva A.I., Tagaeva D.R., Trubnikova M.A., Trunina T.P., Frolov A.G., Khatlamadzhiyan V.V., Khokhlova Yu.I., Chernyavina A.I., Chizhova O.Yu., Shambatov M.A., Shnyukova T.V., Shchukin Yu.V. Patients With Non-Obstructive Coronary Artery Disease and Polyvascular Disease. Sub-Analysis of the Real-World Registry KAMMA (Clinical Registry on Patient Population With Polyvascular Disease in the Russian Federation and Eurasian Countries). Kardiologiia. 2024;64(8):13-23. https://doi.org/10.18087/cardio.2024.8.n2683