Safety and feasibility of nationwide invasive coronary function testing in patients with angina and no obstructive coronary artery disease (NL-CFT)

Abstract

Abstract Background and purpose Patients with angina and no obstructive coronary artery disease (ANOCA) frequently have coronary vasomotor dysfunction (CVDys) as underlying pathophysiological mechanism, comprising epicardial spasm, microvascular spasm and/or microcirculatory dysfunction. These can be diagnosed by invasive coronary function testing (CFT), which has previously shown to be safe in tertiary and expert centres. The prevalence of CVDys and safety and feasibility of CFT is reported on in this first national collaboration network on CFT’s: NL-CFT. Methods NL-CFT is a prospective, observational registry of all consecutive patients undergoing clinically indicated CFT in 15 participating hospitals throughout the Netherlands. A complete CFT consisted of acetylcholine spasm provocation testing and assessment of microcirculatory function by either bolus thermodilution or Doppler flow velocity measurements. The prevalence of six different endotypes based on CFT results and overall safety were assessed and compared between tertiary (n=2) and non-tertiary centres (n=13). Tertiary was defined as having performed over 100 CFT’s prior to the start of NL-CFT and fulfilling a referral function with specialized ANOCA outpatient clinic. Results In total 1207 predominantly female (81%) patients with a mean age of 60±10 years were included. Traditional cardiovascular risk factors were frequently present. Almost all of the included 1207 patients underwent a complete CFT (93.4%) and prevalence of CVDys was high (77%, Fig. 1). There were 11 (0.9%) serious complications reported on, of which three were definitely related to CFT as depicted in Table 1. No procedural death, myocardial infarction or stroke was observed. Lastly, no differences were found in the occurrence of complications between tertiary an non-tertiary centres. Conclusions Coronary function testing is feasible and safe to perform nationally with a high diagnostic yield.Figure 1.Endotype distribution.Table 1.Side-effects&complication rates.