Does Retinal Artery Occlusion Increase the Risk of Following Acute Coronary Syndrome and All-cause Mortality? A Systematic Review and Meta-Analysis

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2025-08-22 DOI:10.1016/j.ajo.2025.08.041

ERFAN HASHEMI , FRANCISCO J. BONILLA-ESCOBAR , HOMA MAZAHERINIA , MEHDI AZIZMOHAMMAD LOOHA , DANIEL SÁNCHEZ-CANO , J. FERNANDO AREVALO

{"title":"Does Retinal Artery Occlusion Increase the Risk of Following Acute Coronary Syndrome and All-cause Mortality? A Systematic Review and Meta-Analysis","authors":"ERFAN HASHEMI , FRANCISCO J. BONILLA-ESCOBAR , HOMA MAZAHERINIA , MEHDI AZIZMOHAMMAD LOOHA , DANIEL SÁNCHEZ-CANO , J. FERNANDO AREVALO","doi":"10.1016/j.ajo.2025.08.041","DOIUrl":null,"url":null,"abstract":"<div><h3>Topic</h3><div>This meta-analysis examined whether retinal artery occlusion (RAO) increases the risk of acute coronary syndrome (ACS) and all-cause mortality compared to non-RAO individuals. It pooled data from 11 studies (502,291,692 participants; 94,410 with RAO) across Asian, European, and American populations, with 5-10 year follow-ups. It assessed how RAO type (Central/CRAO vs. Branch/BRAO), geography, sex, and comorbidities influenced outcomes.</div></div><div><h3>Clinical Relevance</h3><div>Cardiovascular diseases, including ACS and mortality, are a major global burden. The link between RAO—a potential marker of systemic vascular disease—and these outcomes remains unclear, necessitating this comprehensive evaluation.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines (PROSPERO: CRD42023472877), PubMed, EMBASE, Web of Science, and Scopus were searched through June 2024, and then updated on August 11, 2025. Cohort studies reporting RAO's association with ACS or mortality were included. Study quality was assessed using the Newcastle-Ottawa Scale and the GRADE. Pooled relative risks (RR) were calculated using random-effects models.</div></div><div><h3>Results</h3><div>RAO significantly increased the risk of ACS (RR:1.56, 95%CI = 1.22-1.99) and all-cause mortality (RR: 2.00, 95%CI = 1.22-3.28). Risks were higher for CRAO than BRAO for both ACS (RR: 2.70, 95%CI = 1.57-4.66) and mortality (RR: 1.59, 95%CI = 1.27-1.99). Asian populations faced greater ACS (RR: 1.87, 95%CI = 1.45-2.42) and mortality (RR: 4.63, 95%CI = 1.89-11.31) risks versus non-Asian groups. Among comorbidities, atrial fibrillation posed the highest ACS risk (RR: 2.46, 95%CI = 1.34-4.54), followed by hypertension (RR: 1.99, 95%CI = 1.31- 3.03), hyperlipidemia (RR: 1.86, 95%CI = 1.42-2.44), and diabetes (RR: 1.65, 95%CI = 1.11-2.46).</div></div><div><h3>Conclusion</h3><div>RAO is a potential sentinel event and significant independent marker for cardiovascular risk, underscoring the need for thorough cardiovascular assessment and early intervention in affected patients. Prospective studies should clarify causality and explore targeted prevention strategies.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 370-389"},"PeriodicalIF":4.2000,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Ophthalmology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0002939425004465","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Topic

This meta-analysis examined whether retinal artery occlusion (RAO) increases the risk of acute coronary syndrome (ACS) and all-cause mortality compared to non-RAO individuals. It pooled data from 11 studies (502,291,692 participants; 94,410 with RAO) across Asian, European, and American populations, with 5-10 year follow-ups. It assessed how RAO type (Central/CRAO vs. Branch/BRAO), geography, sex, and comorbidities influenced outcomes.

Clinical Relevance

Cardiovascular diseases, including ACS and mortality, are a major global burden. The link between RAO—a potential marker of systemic vascular disease—and these outcomes remains unclear, necessitating this comprehensive evaluation.

Methods

Following PRISMA guidelines (PROSPERO: CRD42023472877), PubMed, EMBASE, Web of Science, and Scopus were searched through June 2024, and then updated on August 11, 2025. Cohort studies reporting RAO's association with ACS or mortality were included. Study quality was assessed using the Newcastle-Ottawa Scale and the GRADE. Pooled relative risks (RR) were calculated using random-effects models.

Results

RAO significantly increased the risk of ACS (RR:1.56, 95%CI = 1.22-1.99) and all-cause mortality (RR: 2.00, 95%CI = 1.22-3.28). Risks were higher for CRAO than BRAO for both ACS (RR: 2.70, 95%CI = 1.57-4.66) and mortality (RR: 1.59, 95%CI = 1.27-1.99). Asian populations faced greater ACS (RR: 1.87, 95%CI = 1.45-2.42) and mortality (RR: 4.63, 95%CI = 1.89-11.31) risks versus non-Asian groups. Among comorbidities, atrial fibrillation posed the highest ACS risk (RR: 2.46, 95%CI = 1.34-4.54), followed by hypertension (RR: 1.99, 95%CI = 1.31- 3.03), hyperlipidemia (RR: 1.86, 95%CI = 1.42-2.44), and diabetes (RR: 1.65, 95%CI = 1.11-2.46).

Conclusion

RAO is a potential sentinel event and significant independent marker for cardiovascular risk, underscoring the need for thorough cardiovascular assessment and early intervention in affected patients. Prospective studies should clarify causality and explore targeted prevention strategies.

查看原文本刊更多论文

视网膜动脉闭塞会增加急性冠状动脉综合征和全因死亡率的风险吗？系统回顾和荟萃分析

这项荟萃分析研究了视网膜动脉闭塞（RAO）是否会增加急性冠状动脉综合征（ACS）的风险和与非RAO个体相比的全因死亡率。该研究汇集了来自亚洲、欧洲和美国人群的11项研究（502,291,692名参与者；94,410名RAO）的数据，随访5-10年。它评估了RAO类型（中央/CRAO vs.分支/BRAO）、地理、性别和合并症对结果的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.