Clinical and prognostic value of biomarkers in patients with non-obstructive coronary artery disease: a systematic review and meta-analysis

Cardiovascular disease (CVD) remains the leading cause of premature mortality worldwide. Among its manifestations, ischemia with non-obstructive coronary arteries (INOCA) and myocardial infarction with non-obstructive coronary arteries (MINOCA) are increasingly recognized and associated with major adverse cardiovascular events. While biomarkers are established tools for diagnosing and predicting outcomes in CVD, their role in INOCA and MINOCA remains unclear. This review summarizes current evidence on cardiovascular biomarkers and their clinical relevance in the context of INOCA and MINOCA.
A systematic review of original studies was conducted using Ovid-MedLine and Embase databases. Eligible studies included adult patients diagnosed with INOCA or MINOCA, with measurements of specific serum biomarkers.
Of 1,493 records identified, 53 were included in the quantitative analysis, encompassing 10 biomarkers. Among inflammatory markers, only C-reactive protein was significantly higher in INOCA patients compared to healthy controls. Metabolic, coagulation and endothelial biomarkers showed no differences. Limited data in the MINOCA population precluded comprehensive biomarker analysis.
Elevated biomarkers of inflammation in INOCA suggest underlying mechanisms such as oxidative stress, cytokine activation, and immune-mediated microvascular dysfunction. Their diagnostic and prognostic potential in INOCA remains promising but requires further validation in clinical studies.