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

Abstract

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. 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. 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. 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). 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.