C-30 | Coronary Functional Angiography results in patients with and without history of Epicardial Coronary Artery Disease

While the majority of angina and no obstructive CAD (ANOCA) patients (pts) have normal coronaries or minimal epicardial CAD (<50% stenosis), there is a unique subset of pts with prior revascularization. Coronary microvascular dysfunction (CMD) and/or epicardial spasm are the most frequent underlying causes of refractory symptoms in ANOCA pts and may exist with and without epicardial CAD. Prospective registry-based cohort study of 317 pts with refractory symptoms who underwent coronary functional angiography (CFA) with normal coronaries or minimal CAD (ANOCA, n=252) compared to those with a history of obstructive CAD with prior revascularization (ANOCA-CADHx, n=65) in regards to demographics, clinical history, and CFA results. Among the 317 pts undergoing CFA, 89% were female, with a median age of 61 years (49, 66). Pts with ANOCA-CADHx had a higher prevalence of hypertension, diabetes, heart failure with preserved ejection fraction (HFpEF), and experienced significantly worse anginal symptoms and impaired functional capacity, as assessed by validated questionnaires (Table 1). Epicardial spasm (to acetylcholine) was more prevalent in ANOCA-CADHx (49% vs. 25%, p<0.001), and CMD (abnormal coronary flow reserve <2.5) was more prevalent in ANOCA pts (66% vs. 42%, p=0.043). Given that CMD and epicardial spasm are highly prevalent in pts with refractory symptoms regardless of whether they had a history of obstructive CAD, CFA should be considered in these pts. While CMD was more prevalent in ANOCA than in ANOCA-CADHx pts, CMD and epicardial spasm are common in both groups and often overlap.