{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T15:44:56Z","timestamp":1761061496080,"version":"3.40.5"},"reference-count":20,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,10,6]],"date-time":"2021-10-06T00:00:00Z","timestamp":1633478400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern Med"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and objectives<\/jats:title><jats:p>The absence of obstructive coronary artery disease (CAD) in patients with angina is common, but its prognosis is debated. We investigated outcomes of such patients to identify predictors of cardiovascular events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We selected 1014 patients with angina, evidence of myocardial ischemia at the electrocardiogram (ECG) exercise test or imaging stress tests, and nonobstructive CAD (absence of lumen diameter reduction \u226550%) at coronary angiography between 1999 and 2015. Note that, 1905 age\u2010 and risk factors\u2010matched asymptomatic subjects served as \u201creal\u2010world\u201d comparators. The primary endpoint was the occurrence of all\u2010cause death or myocardial infarction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At 6\u2010years median follow\u2010up (interquartile range, 3\u20139 years), the primary endpoint occurred in 53 patients (5.5%, 0.92\/100 person\u2010years). Besides similar event rates compared with asymptomatic subjects (hazard ratio [HR] 0.85, 95% confidence interval [CI] 0.62\u20131.15, <jats:italic>p<\/jats:italic> = 0.28), the index population showed a very heterogeneous prognosis. Patients with nonobstructive CAD (HR 1.85, 95% CI 1.02\u20133.37, <jats:italic>p<\/jats:italic> = 0.04, compared with \u201cnormal\u201d coronary arteries) and ischemia at imaging tests (HR 2.11, 95% CI 1.07\u20134.14, <jats:italic>p<\/jats:italic> = 0.03, compared with ischemia detected only at the ECG exercise test) were at higher risk and those with both these components showing even &gt;10\u2010fold event rates as compared with the absence of both. Three\u2010hundred and twenty\u2010five patients (34%) continued to experience angina, 69 (7.2%) underwent repeat coronary angiography, and 14 (1.5%) had consequent coronary revascularization for atherosclerosis progression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Apart from the impaired quality of life, angina without obstructive CAD has an overall benign but very heterogeneous prognosis. Nonobstructive CAD and myocardial ischemia at imaging tests both confer a higher risk.<\/jats:p><\/jats:sec>","DOI":"10.1111\/joim.13390","type":"journal-article","created":{"date-parts":[[2021,9,6]],"date-time":"2021-09-06T16:11:05Z","timestamp":1630944665000},"page":"197-206","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Factors for heterogeneous outcomes of angina and myocardial ischemia without obstructive coronary atherosclerosis"],"prefix":"10.1111","volume":"291","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9177-9547","authenticated-orcid":false,"given":"Francesco","family":"Radico","sequence":"first","affiliation":[{"name":"Institute of Cardiology, \u201cG. d'Annunzio\u201d University  Chieti Italy"},{"name":"ASL 2 Abruzzo  Chieti Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Augusto","family":"Di Castelnuovo","sequence":"additional","affiliation":[{"name":"Mediterranea Cardiocentro  Naples Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Aimo","sequence":"additional","affiliation":[{"name":"Scuola Superiore Sant'Anna Fondazione Toscana Gabriele Monasterio  Pisa Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5455-6010","authenticated-orcid":false,"given":"Marco","family":"Zimarino","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, \u201cG. d'Annunzio\u201d University  Chieti Italy"},{"name":"Interventional Cath Lab  Chieti Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juhani","family":"Knuuti","sequence":"additional","affiliation":[{"name":"Turku PET Centre University of Turku and Turku University Hospital  Turku Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serena","family":"Rossi","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, \u201cG. d'Annunzio\u201d University  Chieti Italy"},{"name":"Interventional Cath Lab  Chieti Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi Emilio","family":"Pastormerlo","sequence":"additional","affiliation":[{"name":"Scuola Superiore Sant'Anna Fondazione Toscana Gabriele Monasterio  Pisa Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luc","family":"Zyw","sequence":"additional","affiliation":[{"name":"Scuola Superiore Sant'Anna Fondazione Toscana Gabriele Monasterio  Pisa Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico","family":"Orsini","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Pisa University Hospital, and University of Pisa  Via Paradisa, 2 Pisa 56124 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7109-1128","authenticated-orcid":false,"given":"Licia","family":"Iacoviello","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Prevention IRCCS Neuromed Mediterranean Neurological Institute  Pozzilli Italy"},{"name":"Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED) University of Insubria  Varese Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danilo","family":"Neglia","sequence":"additional","affiliation":[{"name":"Scuola Superiore Sant'Anna Fondazione Toscana Gabriele Monasterio  Pisa Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Emdin","sequence":"additional","affiliation":[{"name":"Scuola Superiore Sant'Anna Fondazione Toscana Gabriele Monasterio  Pisa Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"de Gaetano","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Prevention IRCCS Neuromed Mediterranean Neurological Institute  Pozzilli 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