Key result
Invasive coronary reactivity testing is a feasible method to identify coronary microvascular dysfunction and risk stratify women with INOCA, where each 0.1 decrease in coronary flow reserve predicts an 8% increase in adverse cardiovascular events.
Why the study?
Women with INOCA are challenging to assess, diagnose, and manage due to a lack of evidence-based guidelines, and are often considered low risk and dismissed without specific therapy.
Does invasive coronary reactivity testing provide useful diagnostic and prognostic information for women with ischemia and no obstructive coronary artery disease?
Does invasive coronary reactivity testing provide useful diagnostic and prognostic information for women with ischemia and no obstructive coronary artery disease?
Invasive coronary reactivity testing safely provides essential prognostic information and helps risk-stratify women with suspected ischemia but no obstructive coronary disease.
PURPOSE OF REVIEW: Two-thirds of women with signs and symptoms of ischemia and no obstructive coronary artery disease (INOCA) have abnormal coronary reactivity. These women are challenging to assess, diagnose and manage because of a lack of evidence-based guidelines. Furthermore, they are considered to be at 'low risk' by most physicians, often receive no specific therapy and tend to be dismissed from subspecialty care. RECENT FINDINGS: Coronary reactivity testing (CRT) is considered the reference-standard for evaluation of epicardial and microvascular coronary function in response to various vasoactive agents. It provides a comprehensive vascular function assessment for diagnosis, a guide for management, and has prognostic benefit that outweighs the risk of the procedure. We recently demonstrated the prognostic value of assessing coronary vascular reactivity in women with signs and symptoms of ischemia, especially those with no obstructive coronary artery disease. SUMMARY: Invasive CRT is a feasible, useful method to identify coronary microvascular dysfunction (CMD) and risk stratify women with INOCA. It has a comparable safety record with other invasive procedures. Future research is directed at optimizing patient selection, streamlining of invasive CRT methods using user-friendly catheters to enhance feasibility in the routine clinical setting, and optimizing treatment protocols, with clinical trials designed to evaluate outcomes.
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AlBadri et al. (2019) conducted a review in Ischemia and no obstructive coronary artery disease (INOCA) / Coronary microvascular dysfunction (CMD). Coronary reactivity testing (CRT) was evaluated on Adverse cardiovascular events associated with decreased coronary flow reserve (CFR) (HR 1.08, 95% CI 1.01-1.16, p=0.036). Invasive coronary reactivity testing is a feasible method to identify coronary microvascular dysfunction and risk stratify women with INOCA, where each 0.1 decrease in coronary flow reserve predicts an 8% increase in adverse cardiovascular events.
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