Among patients with moderate or severe ischemia, women had a 4.19-fold higher odds of having ischemia with non-obstructive coronary arteries compared to men.
Observational (n=3,612)
Blinded core laboratory review
Yes
In patients with moderate or severe ischemia on stress testing, INOCA is present in 13%, is strongly associated with female sex, and its severity does not correlate with the extent of nonobstructive atherosclerosis.
Odds Ratio: 4.19 (95% CI 3.37–5.2)
p-value: p=<0.001
BACKGROUND: Ischemia with nonobstructive coronary arteries (INOCA) is common clinically, particularly among women, but its prevalence among patients with at least moderate ischemia and the relationship between ischemia severity and non-obstructive atherosclerosis severity are unknown. OBJECTIVES: The authors investigated predictors of INOCA in enrolled, nonrandomized participants in ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches), sex differences, and the relationship between ischemia and atherosclerosis in patients with INOCA. METHODS: Core laboratories independently reviewed screening noninvasive stress test results (nuclear imaging, echocardiography, magnetic resonance imaging or nonimaging exercise tolerance testing), and coronary computed tomography angiography (CCTA), blinded to results of the screening test. INOCA was defined as all stenoses <50% on CCTA in a patient with moderate or severe ischemia on stress testing. INOCA patients, who were excluded from randomization, were compared with randomized participants with ≥50% stenosis in ≥1 vessel and moderate or severe ischemia. RESULTS: Among 3,612 participants with core laboratory-confirmed moderate or severe ischemia and interpretable CCTA, 476 (13%) had INOCA. Patients with INOCA were younger, were predominantly female, and had fewer atherosclerosis risk factors. For each stress testing modality, the extent of ischemia tended to be less among patients with INOCA, particularly with nuclear imaging. There was no significant relationship between severity of ischemia and extent or severity of nonobstructive atherosclerosis on CCTA. On multivariable analysis, female sex was independently associated with INOCA (odds ratio: 4.2 95% CI: 3.4-5.2). CONCLUSIONS: Among participants enrolled in ISCHEMIA with core laboratory-confirmed moderate or severe ischemia, the prevalence of INOCA was 13%. Severity of ischemia was not associated with severity of nonobstructive atherosclerosis. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches ISCHEMIA; NCT01471522).
Reynolds et al. (Wed,) conducted a observational in Ischemia with Non-Obstructive Coronary Arteries (INOCA) (n=3,612). Female sex vs. Male sex was evaluated on Presence of INOCA (OR 4.19, 95% CI 3.37-5.20, p=<0.001). Among patients with moderate or severe ischemia, women had a 4.19-fold higher odds of having ischemia with non-obstructive coronary arteries compared to men.