Caitlin Vink

69 Meta-analysis and systematic review of coronary vasospasm in ANOCA patients CAS in different continents When studies were evaluated based on ethnicity, random effects analysis showed a significant different prevalence of epicardial spasm between Western World populations of 33% (8 studies, n = 2,881 ANOCA patients, 95% CI, 23%–45%),8, 9, 12, 14, 20, 22, 27, 28 vs. 52% (95% CI, 36%–66%) and Asian populations (9 studies, n = 8,931 ANOCA patients)11, 17–19, 23–25, 30, 31 (p = 0.014) (Figure 2). When microvascular spasm was compared between continents, random effects analysis showed a prevalence in Western World populations of 33% (5 studies, n = 1,893 ANOCA patients, 95% CI, 26%–41%),8, 9, 14, 22, 27 vs. 20% (95% CI, 16%–36%) in Asian populations (5 studies, n = 304 ANOCA patients),17, 19, 23, 24, 30 which did not reach statistical significance (Figure 3). A numerical difference that did not reach statistical significance was seen in the prevalence of epicardial spasm in women from Western World populations compared to women from Asian populations (57% vs. 35%, respectively) (Table 2). Additionally, diabetes mellitus was seen significantly more often in Asian populations with epicardial spasm (21% vs. 13%, p < 0.01) and dyslipidemia in Western World populations with epicardial spasm (56% vs. 40%, p < 0.01) (Table 2). Due to insufficient data it was not feasible to compare CV risk factors in microvascular spasm patients between Western World and Asian publications. CAS and sex differences Sixteen studies compared ANOCA patients with and without epicardial spasm (16 studies; n = 6117). Of the ANOCA patients with epicardial spasm 39% (95% CI 29%- 50%) were women, compared to 53% (95% CI, 47%-59%) of ANOCA patients without epicardial spasm [OR 0.56 (CI 0.37–0.84); P < 0.01] (Table 3).8, 9, 13, 16–20, 23–25, 27, 29–32 Four studies compared ANOCA patients with and without microvascular spasm (n = 466).8, 9, 17, 24 In microvascular spasm patients 64% (95% CI, 27%-90%) were women compared to 48% (95% CI, 20%-77%) of ANOCA patients without microvascular spasm, which did not reach statistical significance (Supplementary Table S6). In addition, 3 articles (n = 2437) compared CV risk factors between female and male epicardial spasm patients, which is shown in Supplementary Table S8.9, 15, 31 Due to insufficient data it was not feasible to compare CV risk factors between female and male microvascular spasm patients. 4

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