January 10, 2026КАРДИОЛОГИЯ УЗБЕКИСТАНА2 citations
View Full PaperComparison of International Expert Working Group Algorithms for Diagnosing Angina With Nonobstructive Coronary Arteries
Key Result
The MVN algorithm identified 88.2% of patients as having ANOCA compared to 53.5% with the EAPCI algorithm, indicating a significantly higher diagnostic yield (P < 0.001).
Key Points
- To compare the diagnostic accuracy of the EAPCI and MVN algorithms for angina with nonobstructive coronary arteries (ANOCA).
- Assessment of various tests including fractional flow reserve and coronary flow reserve in a cohort with clinically suspected ANOCA.
- Intravascular ultrasound and acetylcholine provocation were performed.
- Reclassification of patients based on diagnostic results from each algorithm.
- EAPCI algorithm identified ANOCA in 53.5% of patients, while MVN identified 88.2%, with a significant overall difference.
- 66.7% of patients initially classified as noncardiac chest pain by EAPCI were reclassified as ANOCA by MVN.
- 84.3% of obstructive coronary artery disease patients identified by EAPCI were reclassified into ANOCA by MVN.
- Patients with cardiac chest pain had a significantly lower mean Seattle Angina Questionnaire score compared to noncardiac chest pain (51.0 vs 56.1).
Structured PICO
Does the MVN algorithm improve the diagnostic yield for ANOCA endotypes compared to the EAPCI algorithm in patients with suspected ANOCA?
P
Population
516 patients referred for clinically suspected angina with nonobstructive coronary arteries (ANOCA)
I
Intervention
Microvascular Network (MVN) algorithm (coronary function testing including assessment for coronary artery spasm, microvascular dysfunction, myocardial bridging, and endothelial dysfunction)
C
Comparator
European Association of Percutaneous Cardiovascular Interventions (EAPCI) algorithm (coronary function testing including assessment for coronary artery spasm and microvascular dysfunction only)
O
Outcome
Diagnostic yield for ANOCA endotypes (prevalence of ANOCA, obstructive coronary artery disease, and noncardiac chest pain)
The MVN algorithm, which incorporates testing for myocardial bridging and endothelial dysfunction, significantly increases the diagnostic yield of ANOCA compared to the EAPCI algorithm.
Main Result
Absolute Event Rate: 0% vs 0%
Abstract
BACKGROUND: Coronary function testing (CFT) protocols in patients with angina with nonobstructive coronary arteries (ANOCA) differ among expert working groups. The European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorses testing for coronary artery spasm and microvascular dysfunction, while the Microvascular Network (MVN) recommends additional assessment for myocardial bridging and endothelial dysfunction. OBJECTIVES: The aim of this study was to compare the diagnostic yield between the EAPCI and MVN algorithms in a large cohort of patients with ANOCA. METHODS: Fractional flow reserve, coronary flow reserve, index of microcirculatory resistance, intravascular ultrasound, acetylcholine provocation, and myocardial bridging assessment were performed in patients referred for clinically suspected ANOCA. RESULTS: Among 516 patients, the prevalence of ANOCA, obstructive coronary artery disease, and noncardiac chest pain was 53.5%, 20.9%, and 25.6%, respectively, according to the EAPCI algorithm, compared with 88.2%, 3.3%, and 8.5% according to the MVN algorithm (P < 0.001 for overall difference). Of 132 patients classified as noncardiac chest pain by the EAPCI algorithm, 66.7% were reclassified into an ANOCA endotype using the MVN algorithm. Similarly, 84.3% of 108 patients diagnosed with obstructive coronary artery disease using the EAPCI algorithm were reclassified into an ANOCA endotype by the MVN algorithm. The mean Seattle Angina Questionnaire summary score was significantly lower in patients with cardiac chest pain compared with those with noncardiac chest pain (51.0 vs 56.1; P = 0.030) as defined by the MVN algorithm. CONCLUSIONS: The MVN algorithm results in a higher diagnostic yield for ANOCA endotypes compared with the EAPCI algorithm. Routine testing for myocardial bridging and endothelial dysfunction should be considered in patients with suspected ANOCA.