Abstract 15736: Coronary Angiography Alone Compared With Invasive Coronary Function Testing in Women With Ischemia and No Obstructive Coronary Artery Disease

Abstract

Introduction: Ischemic heart disease is a leading cause of morbidity and mortality in women. Women frequently suffer from ischemia and no obstructive coronary artery disease (INOCA) which includes phenotypes of coronary microvascular dysfunction (CMD) or coronary vasospasm (VA). Between 30-60% of women referred for invasive angiography have non obstructive coronary arteries, leaving many patients without a definitive diagnosis. Objective: We sought to determine the real-world diagnostic yield of invasive physiological testing in women with INOCA, and to describe downstream care regarding modifications to medical therapy based on the eventual diagnosis. Methods: We included 198 women who underwent either coronary angiography (CA, N=99) alone or coronary function testing (CFT, N=99) comprised of acetylcholine provocation and assessment of coronary flow reserve and the index of microcirculatory resistance. We performed a descriptive retrospective analysis of demographics, pre-procedure diagnostic testing and used logistic regression to compare the findings of angiography, post-procedure diagnosis, and changes to cardiac medications across cohorts. Results: The mean age was 62 ± 10 (CA alone) compared with 57 ± 10 years (CFT). Patients were mostly white (72% CA vs 79% CFT). An angiography-based diagnosis of normal coronary arteries was found in 21% CA alone (N=21) vs 48% in CFT (N=48) and non-obstructive CAD in 79% CA alone (N=78) vs 51% CFT (N=50), p<0.001. Of the women who underwent CFT, 76% (N=75) were diagnosed with a vasomotor disorder stratified by endotype of CMD 34% (n=34), VA 22% (n=22), mixed CMD/VA 10% (N=10) or endothelial dysfunction 20% (N=20). Medications were changed after angiography in 41% in the CA alone group compared to 67% in the CFT group, p<0.001; while medication changes at 30 days occurred in 22% CA alone vs 45% in the CFT group, p<0.001. Conclusions: Our findings demonstrate that women presenting with suspected ischemic heart disease undergoing coronary angiography often received a diagnosis of non-obstructive coronary artery disease; whereas those undergoing CFT were diagnosed with coronary vasomotor disorders. In our institution, medication changes occurred more frequently after a CFT-confirmed diagnosis.