E-6 | Diagnostic Yield of Invasive Coronary Function Testing Compared With Coronary Angiography Alone in Women With Stable Ischemic Heart Disease

Abstract

Objective: The aim of this study was to compare the diagnostic yield of invasive coronary function testing (CFT) and coronary angiography (CA) alone in women who presented with stable ischemic heart disease (SIHD). SIHD is a leading cause of morbidity and mortality in women, and women are more likely than men to suffer from ischemia and no obstructive coronary artery disease (INOCA). Endotypes of INOCA such as coronary vasospasm and microvascular dysfunction are not identified by routine coronary angiography. As a result, many women who undergo cardiac catheterization for suspected SIHD are not given a specific diagnosis or a targeted therapeutic plan. The diagnostic yield of CFT in comparison with CA alone in women has not been well-established. We conducted a retrospective study of women who presented with symptoms of SIHD. The primary outcome was post-procedure diagnosis identified after invasive CFT or CA. Secondary outcomes included post procedure change in cardiac medications and complications. A total of 133 women were evaluated, including 61 in the CFT group and 72 in the CA group. Compared to the CA group, women in the CFT group were more likely to receive a diagnosis of microvascular dysfunction 41% (n=25) vs. 3% (n=2), vasospastic angina 20% (n=12) vs. 1% (n=1), or endothelial dysfunction (n=5, 8% vs 0%). Other diagnoses in the CFT group included elevating resting flow (n=2), myocardial bridging (n=3), or mixed syndromes (n=5). In the CA group, women most commonly received a diagnosis of normal coronary arteries (n=15, 21%), non-obstructive coronary artery disease (n=54, 75%), or other (n=2, 3%). Post-procedure medication changes were more frequent in the CFT group compared to the CA group (69% vs 43%, p<0.001). In this study of women with SIHD, CFT confirmed an underlying vasomotor disorder in 85% of cases, whereas CA only reported a diagnosis of normal coronary arteries or non-obstructive CAD. CFT was able to further categorize women as having microvascular dysfunction or vasospastic angina, resulting in a higher frequency of post-procedure medication changes compared to CA alone. These findings suggest that CFT should be considered routinely in the evaluation of women with suspected SIHD.