Patients with nonobstructive coronary artery disease are at significantly greater risk of myocardial infarction and all-cause mortality than are those with no CAD, and research is needed to explore risk mitigation methods in this group, say the authors of a retrospective cohort study.

The study of 37,674 U.S. veterans undergoing elective coronary angiography for CAD found patients with one-vessel nonobstructive CAD were at double the risk of a MI within 1 year, compared with those with no apparent CAD (see chart), and showed a 60% increase in mortality among individuals with three-vessel nonobstructive CAD.

“The 1-year MI risk progressively increased by CAD extent, rather than abruptly increasing between nonobstructive and obstructive CAD,” wrote Dr. Thomas M. Maddox of the Denver Veterans Affairs Medical Center and his colleagues, in an article published online Nov. 4 (JAMA 2014;312:1754-63 [ doi:10.1001/jama.2014.14681 ]). [However] empirical evidence is lacking as to whether these patients benefit from the prevention therapies recommended for their obstructive CAD counterparts.”

The study was supported by the Department of Veterans Affairs Office of Information and Analytics. Authors declared a variety of funding, directorships, and committee positions in public and private industry.


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