Safety of Coronary Reactivity Testing in Women With No Obstructive Coronary Artery Disease

• Type of Material: Article
• Authors: Janet Wei, Cedars-Sinai Medical Center; Puja Kiran Mehta, Emory University; B. Delia Johnson, University of Pittsburgh; Bruce Samuels, Cedars-Sinai Medical Center; Saibal Kar, Cedars-Sinai Medical Center; R. David Anderson, University of Florida; Babak Azarbal, Cedars-Sinai Medical Center; John Petersen, University of Florida; Barry Sharaf, Brown University; Eileen Handberg, University of Florida; Chrisandra Shufelt, Cedars-Sinai Medical Center; Kamlesh Kothawade, Cedars-Sinai Medical Center; George Sopko, National Institutes of Health; Amir Lerman, Mayo Clinic; Leslee J Shaw, Emory University; Sheryl F. Kelsey, University of Pittsburgh; Carl J. Pepine, University of Florida; C. Noel Bairey Merz, Cedars-Sinai Medical Center
• Language: English
• Date: 2012-06-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 American College of Cardiology Foundation.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jcin.2012.01.023
• Title of Journal or Parent Work: JACC: Cardiovascular Interventions
• ISSN: 1936-8798
• Volume: 5
• Issue: 6
• Start Page: 646
• End Page: 653
• Grant/Funding Information: This work was supported by contracts from the National Heart, Lung and Blood Institutes, nos. N01-HV-68161, N01-HV-68162, N01-HV-68163, N01-HV-68164, grants U0164829, U01 HL649141, U01 HL649241, T32HL69751, 1R03AG032631 from the National Institute on Aging, GCRC grant MO1-RR00425 from the National Center for Research Resources and grants from the Gustavus and Louis Pfeiffer Research Foundation, Danville, NJ, The Women’s Guild of Cedars-Sinai Medical Center, Los Angeles, CA, The Ladies Hospital Aid Society of Western Pennsylvania, Pittsburgh, PA, and QMED, Inc., Laurence Harbor, NJ, the Edythe L. Broad Women’s Heart Research Fellowship, Cedars-Sinai Medical Center, Los Angeles, California, and the Barbra Streisand Women’s Cardiovascular Research and Education Program, Cedars-Sinai Medical Center, Los Angeles.
• Keywords: microvascular dysfunction; ACUTE MYOCARDIAL-INFARCTION; SYNDROME EVALUATION WISE; ISCHEMIA-SYNDROME-EVALUATION; ENDOTHELIAL FUNCTION; Cardiovascular System & Cardiology; endothelial dysfunction; coronary reactivity; Science & Technology; ASSOCIATION TASK-FORCE; Life Sciences & Biomedicine; PRACTICE GUIDELINES COMMITTEE; MICROVASCULAR DYSFUNCTION; CARDIOVASCULAR EVENTS; NATIONAL-HEART; Cardiac & Cardiovascular Systems; FRACTIONAL FLOW RESERVE
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Objectives: This study evaluated the safety of coronary reactivity testing (CRT) in symptomatic women with evidence of myocardial ischemia and no obstructive coronary artery disease (CAD). Background: Microvascular coronary dysfunction (MCD) in women with no obstructive CAD portends an adverse prognosis of a 2.5% annual major adverse cardiovascular event (MACE) rate. The diagnosis of MCD is established by invasive CRT, yet the risk of CRT is unknown. Methods: The authors evaluated 293 symptomatic women with ischemia and no obstructive CAD, who underwent CRT at 3 experienced centers. Microvascular function was assessed using a Doppler wire and injections of adenosine, acetylcholine, and nitroglycerin into the left coronary artery. CRT-related serious adverse events (SAEs), adverse events (AEs), and follow-up MACE (death, nonfatal myocardial infarction [MI], nonfatal stroke, or hospitalization for heart failure) were recorded. Results: CRT-SAEs occurred in 2 women (0.7%) during the procedure: 1 had coronary artery dissection, and 1 developed MI associated with coronary spasm. CRT-AEs occurred in 2 women (0.7%) and included 1 transient air microembolism and 1 deep venous thrombosis. There was no CRT-related mortality. In the mean follow-up period of 5.4 years, the MACE rate was 8.2%, including 5 deaths (1.7%), 8 nonfatal MIs (2.7%), 8 nonfatal strokes (2.7%), and 11 hospitalizations for heart failure (3.8%). Conclusions: In women undergoing CRT for suspected MCD, contemporary testing carries a relatively low risk compared with the MACE rate in these women. These results support the use of CRT by experienced operators for establishing definitive diagnosi s and assessing prognosis in this at-risk population. (Women's Ischemia Syndrome Evaluation [WISE] ; NCT00832702).