Diagnostic Yield and Clinical Utility of Coronary Angiography Versus Coronary Function Testing in Women With Angina and Nonobstructive Coronary Arteries.

Autor: Cigarroa N; Yale New Haven Hospital New Haven New Haven CT., Latif N; Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT., Maayah M; Department of Psychiatry and Women's Health Research at Yale Yale University School of Medicine New Haven CT., Khokhar A; Yale New Haven Hospital New Haven New Haven CT., Kunnirickal S; Division of Interventional Cardiology The Valley Hospital Ridgewood NJ., Schwann A; Yale New Haven Hospital New Haven New Haven CT., Maciejewski KR; Yale Center for Analytical Sciences New Haven CT., Odanovic N; Yale New Haven Hospital New Haven New Haven CT.; Institute for Cardiovascular Diseases 'Dedinje' Belgrade Serbia., Mazure CM; Department of Psychiatry and Women's Health Research at Yale Yale University School of Medicine New Haven CT., Spatz E; Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT., Pfau S; Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT.; Veterans Affairs Connecticut Healthcare System West Haven CT., Lansky A; Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT., Shah SM; Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT.; Veterans Affairs Connecticut Healthcare System West Haven CT.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2024 Oct; Vol. 13 (19), pp. e035852. Date of Electronic Publication: 2024 Sep 18.
DOI: 10.1161/JAHA.124.035852
Abstrakt: Background: Approximately 50% of women referred for invasive coronary angiography have angina and nonobstructive coronary arteries, which includes coronary microvascular dysfunction, vasospastic angina, and other vasomotor disorders. We sought to determine the real-world diagnostic yield of invasive coronary angiography and coronary function testing in women with angina and nonobstructive coronary arteries.
Methods and Results: From 2018 to 2023, we enrolled 198 women who underwent either coronary angiography (CA) alone (n=99) or coronary function testing (CFT; n=99). Mean±SD age was 62±10 years (CA alone) compared with 57±10 years (CFT). Coronary angiography was interpreted as nonobstructive coronary artery disease more frequently after CA alone (79% versus 52%). Of the women who underwent CFT, 82% (N=81) were found to have vasomotor disorders, including coronary microvascular dysfunction (27%), vasospastic angina (32%), mixed coronary microvascular dysfunction/vasospastic angina (16%), endothelial dysfunction (10%; without spasm), elevated resting flow (2%), or symptomatic myocardial bridging (4%). Compared with women undergoing CA alone, medications were changed more frequently after CFT at 24 hours (41% versus 65%; P =0.001) and between 24 hours and 30 days (30% versus 44%; P =0.04) with intensification of antianginal therapy (79% versus 92%; P< 0.0001) and increased use of calcium channel blockers (36% versus 63%; P< 0.0001).
Conclusions: Our findings demonstrate that women presenting with suspected ischemic heart disease undergoing CA alone only received an anatomic diagnosis, whereas >80% of women undergoing CFT received a specific diagnosis of a coronary vasomotor disorder and greater intensification of antianginal therapy.
Databáze: MEDLINE
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