Patients with angina and non-obstructive coronary artery disease undergoing comprehensive invasive coronary function testing: long-term clinical outcomes

Background and aims Comprehensive evaluation by invasive coronary function test (CFT) of patients with angina and non-obstructive coronary artery disease is recommended in current guidelines. The prognosis of patients with CFT-proven coronary vasomotor dysfunction (CVDys) is less well-known. Methods Patients that provided consent for the previously published NL-CFT registry who underwent clinically indicated invasive CFT between February 1st, 2019 and June 1st, 2024 were included. Patients with CVDys defined as an abnormal spasm provocation test and/or microvascular functional assessment, were compared to patients with normal CFT. The primary outcome of major adverse cardiovascular events and emergency room visits for angina (MACE-EA) was defined as a composite of all-cause death, acute coronary syndrome, stroke/transient ischaemic attack, revascularization, repeat angiography without intervention, heart failure hospitalizations and unplanned hospitalizations or emergency room visits due to angina. Results In total, 1355 patients were included. In 79.8%, CFT was abnormal, vasospasm was the most prevalent endotype. In 1252 patients follow-up of clinical events was complete. During a mean follow-up of 33±13 months, CVDys patients had almost double the number of primary outcome events compared to patients with a normal CFT (31.2% vs 16.8%, p<0.001), driven by emergency care visits for angina. Secondary clinical endpoints including death, myocardial infarction, stroke or revascularization were low and comparable between the groups. Conclusions The long-term risk of MACE-EA is doubled in ANOCA patients with CFT-confirmed CVDys compared to normal CFT results. Events are dominated by emergency room visits due to angina, illustrating the high disease burden of CVDys. Their (angina-related) health status is significantly worse at follow-up.