ANOCA Patients With Prior Obstructive Coronary Artery Disease and PCI Have Higher Odds of Epicardial Spasm

BACKGROUND: Up to 50% of patients undergoing coronary angiography have angina with no obstructive coronary arteries (ANOCA). Among ANOCA patients, 2 distinct groups exist: patients with and without a history of prior obstructive coronary artery disease (CAD) treated with percutaneous coronary intervention (PCI). OBJECTIVES: This study aims to evaluate associations between history of prior obstructive CAD treated with PCI and coronary microvascular and vasomotor dysfunction endotypes in ANOCA patients. METHODS: A prospective Coronary Microvascular and Vasomotor Dysfunction Registry of consecutive ANOCA patients undergoing invasive coronary functional testing (ICFT). RESULTS: Among 624 ANOCA patients undergoing ICFT, 11% had prior obstructive CAD treated with PCI. ANOCA patients with prior obstructive CAD had a higher prevalence of males, were older, and had higher rates of cardiovascular risk factors. Prior obstructive CAD treated with PCI was associated with an 11-point lower Seattle Angina Questionnaire 7 summary score in unadjusted (β -11.0; 95% CI: -17.0 to -4.4; P = 0.001) and adjusted models. Patients with prior obstructive CAD treated with PCI had a higher prevalence of epicardial spasm by angiographic criteria (70% vs 34%; P < 0.001) and 4.55-fold higher odds of epicardial spasm in unadjusted (OR: 4.55; 95% CI: 2.65-8.07; P < 0.001) and adjusted models, with similar odds of coronary microvascular dysfunction. CONCLUSIONS: Among ANOCA patients, those with prior obstructive CAD treated with PCI had over a 4-fold higher odds of epicardial spasm. These findings underscore the need for comprehensive ICFT in ANOCA patients with prior PCI.