Abnormal Coronary Reactivity and Long-term Outcomes in Women

Microvascular impairment in women with signs and symptoms of ischemia was predictive of adverse cardiovascular outcomes, a new analysis suggests.

The study researchers, publishing in the Journal of the American College of Cardiology, included 224 women from the Women’s Ischemia Syndrome Evaluation (WISE) study with and without obstructive coronary artery disease and signs and symptoms of ischemia; the study population then underwent coronary reactivity testing. The researchers obtained coronary flow reserve and coronary blood flow data, and tested epicardial coronary reactivity by dilation response to intracoronary acetylcholine and intracoronary nitroglycerin. The primary study endpoints were major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction, stroke, and heart failure. Mean follow-up was 9.7 years.

Impaired microvasculature function assessed invasively adversely affects outcome in women @JACCJournals https://t.co/YYTz58yFN9 #CardioEd #cardiotwitter #EchoFirst #WhyCMR pic.twitter.com/SKzgv2yfIH

— Vass Vassiliou (@vass_vassiliou) February 12, 2019

The authors reported 129 events during the follow-up period. According to the results, low coronary flow reserve was a predictor of higher MACE rates (P=0.021), and low coronary blood flow was predictive of an increased mortality risk (P=0.038), as well as an increased risk for MACE (P=0.006) after adjustment for cardiovascular risk factors. While there was no association between epicardial intracoronary nitroglycerin, a decrease in cross-sectional area in response to intracoronary acetylcholine was associated with a greater risk for angina hospitalization (P<0.0001).

More evidence that not all #HeartAttack s are created equal, especially in women… Among #women with normal epicardial coronary arteries, abnormal coronary microvascular function predicts adverse cardiovascular outcomes. https://t.co/fMuAiOFEfV

— Thais Coutinho (@thaiscoutinhoCV) February 12, 2019

“On longer-term follow-up, impaired microvascular function predicts adverse cardiovascular outcomes in women with signs and symptoms of ischemia,” the research team wrote in their abstract. “Evaluation of CR abnormality can identify those at higher risk of adverse outcomes in the absence of significant CAD.”

https://twitter.com/CoronaryDoc/statuses/1095157708322471937

Thank you @JACCJournals for accepting our work from #WISE. Hope CorMicA @TomJFord @ColinBerryMD will address the treatment options in #CMD @lesleejshaw @JanetWeiMD @HenrytTimothy @EmoryUniversity @EmoryDeptofMed @gina_lundberg @emorywomenheart @CedarsSinai https://t.co/qe6z5qlkxw pic.twitter.com/9JibFCNvhd

— Ahmed AlBadri, MD (@ahmedalbadrimd) February 12, 2019

Nice extension of the #WISE study f/ @JACCJournals showing 10 year outcomes (MACE and mortality) worse in women with impaired coronary reactivity. Important to test for this @drmeghaprasad ! https://t.co/eK6io4zObX

— R. Jay Widmer (@DrArgyle) February 12, 2019

Source: JACC