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

• 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
• Journal Title: JACC: Cardiovascular Interventions
• Volume: Volume 5, Number 6
• Publisher: Elsevier: 12 months | 2012-06-01, Pages 646-653
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.jcin.2012.01.023
• Subjects: Health Sciences, Epidemiology; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; coronary reactivity; endothelial dysfunction; microvascular dysfunction; ISCHEMIA-SYNDROME-EVALUATION; SYNDROME EVALUATION WISE; PRACTICE GUIDELINES COMMITTEE; ACUTE MYOCARDIAL-INFARCTION; FRACTIONAL FLOW RESERVE; ASSOCIATION TASK-FORCE; MICROVASCULAR DYSFUNCTION; CARDIOVASCULAR EVENTS; ENDOTHELIAL FUNCTION; NATIONAL-HEART

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).