C-37 | No difference in anginal symptoms and coronary microvascular disease in Angina vs Ischemia with no obstructive coronary artery disease (ANOCA/INOCA)

Up to 50-70% of patients undergoing invasive coronary angiography for evaluation of angina have absence of obstructive coronary artery disease (CAD) now referred to as ANOCA. Among ANOCA patients a proportion have evidence of ischemia on stress testing. It remains unknown where there are differences between patients with evidence of ischemia on prior stress testing (INOCA) and those without (ANOCA). In a prospective registry-based study among patients without obstructive CAD (defined as <50% stenosis in epicardial artery) undergoing invasive coronary functional angiography (CFA), we assessed clinical characteristics, symptoms, and diagnoses (CMD defined as abnormal coronary flow reserve <2.5 to adenosine or epicardial spasm to acetylcholine testing) in patients with ischemia on stress test imaging (INOCA) as compared to patients with negative stress test imaging (ANOCA). Among the 252 patients who underwent CFA, 92% were female with a median age of 57 years (48,66) and 35% had INOCA. No significant differences in clinical characteristics, anginal symptoms or functional capacity in patients with ANOCA as compared to INOCA. Prevalence of CMD and epicardial spasm was similar in both groups (Table). Despite evidence of ischemia in INOCA patients, there were no differences in anginal symptoms, functional capacity or prevalence of CMD or epicardial spasm as compared to ANOCA patients. CFA should be considered in all ANOCA patients regardless of the presence of ischemia on stress testing.