Lower coronary flow reserve was associated with increased risk of major adverse outcomes (HR 1.16; 95% CI 1.04-1.30; P=0.009), with rates of 26.7% vs 12.2% for CFR <2.32 vs ≥2.32.
Cohort (n=189)
Does coronary microvascular dysfunction (measured by CFR after intracoronary adenosine) predict major adverse outcomes in women with suspected ischemia?
Coronary microvascular dysfunction, indicated by a CFR <2.32 after intracoronary adenosine, significantly predicts major adverse cardiovascular outcomes in women with suspected ischemia.
Hazard Ratio: 1.16 (95% CI 1.04–1.3)
Absolute Event Rate: 26.7% vs 12.2%
p-value: p=0.009
OBJECTIVES: We investigated whether coronary microvascular dysfunction predicts major adverse outcomes during follow-up among women with signs and symptoms of ischemia. BACKGROUND: Altered coronary reactivity occurs frequently in women evaluated for suspected ischemia, and the endothelium-dependent component is linked with adverse outcomes. Possible links between endothelium-independent microvascular coronary reactivity and adverse outcomes remain uncertain. METHODS: As part of the National Heart, Lung and Blood Institute-sponsored WISE (Women's Ischemia Syndrome Evaluation), we investigated relationships between major adverse outcomes and baseline coronary flow reserve (CFR) after intracoronary adenosine in 189 women referred to evaluate suspected ischemia. RESULTS: At a mean of 5.4 years, we observed significant associations between CFR and major adverse outcomes (death, nonfatal myocardial infarction, nonfatal stroke, or hospital stay for heart failure). An exploratory receiver-operator characteristic analysis identified CFR or=2.32 event rate 12.2%; p = 0.01). Lower CFR was associated with increased risk for major adverse outcomes (hazard ratio: 1.16, 95% confidence interval: 1.04 to 1.30; p = 0.009). This held true among the 152 women without obstructive coronary artery disease (CAD) (hazard ratio: 1.20, 95% confidence interval: 1.05 to 1.38; p = 0.008). The CFR significantly improved prediction of adverse outcomes over angiographic CAD severity and other risk conditions. CONCLUSIONS: Among women with suspected ischemia and atherosclerosis risk factors, coronary microvascular reactivity to adenosine significantly improves prediction of major adverse outcomes over angiographic CAD severity and CAD risk factors. These findings suggest that coronary microvessels represent novel targets for diagnostic and therapeutic strategies to predict and limit adverse outcomes in women. (Women's Ischemia Syndrome Evaluation WISE; NCT00000554).
“When a diagnosis of this condition is missed, women are not treated for their angina and high cholesterol and they remain at high risk for having a heart attack. This study and the high prevalence of coronary microvascular dysfunction demonstrate that we must think out of the box when it comes to the evaluation and diagnosis of heart disease in women.”
Pepine et al. (2010) conducted a cohort in suspected ischemia (n=189). Coronary flow reserve <2.32 vs. Coronary flow reserve ≥2.32 was evaluated on major adverse outcomes (death, nonfatal myocardial infarction, nonfatal stroke, or hospital stay for heart failure) (HR 1.16, 95% CI 1.04-1.30, p=0.009). Lower coronary flow reserve was associated with increased risk of major adverse outcomes (HR 1.16; 95% CI 1.04-1.30; P=0.009), with rates of 26.7% vs 12.2% for CFR <2.32 vs ≥2.32.