Division of Cardiology, Women's Heart Center, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
JACC Cardiovasc Interv. 2012 Jun;5(6):646-53. doi: 10.1016/j.jcin.2012.01.023.
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).
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.
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.
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%).
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 diagnosis and assessing prognosis in this at-risk population. (Women's Ischemia Syndrome Evaluation [WISE]; NCT00832702).
本研究评估了有心肌缺血证据且无阻塞性冠状动脉疾病（CAD）的症状性女性进行冠状血管反应性测试（CRT）的安全性。
无阻塞性 CAD 的女性存在微血管冠状动脉功能障碍（MCD），预示着其每年主要不良心血管事件（MACE）发生率为 2.5%。MCD 的诊断通过有创性 CRT 确立，但 CRT 的风险未知。
作者评估了在 3 家经验丰富的中心接受 CRT 的 293 名有缺血且无阻塞性 CAD 的症状性女性。使用多普勒导丝和向左侧冠状动脉注射腺苷、乙酰胆碱和硝酸甘油来评估微血管功能。记录 CRT 相关的严重不良事件（SAE）、不良事件（AE）和随访期间的 MACE（死亡、非致死性心肌梗死[MI]、非致死性卒中和因心力衰竭住院）。
在 2 名女性（0.7%）的 CRT 过程中发生了 CRT-SAE：1 例发生冠状动脉夹层，1 例发生与冠状动脉痉挛相关的 MI。2 名女性（0.7%）发生 CRT-AE，包括 1 例短暂空气微栓塞和 1 例深静脉血栓形成。无 CRT 相关死亡。平均随访 5.4 年后，MACE 发生率为 8.2%，包括 5 例死亡（1.7%）、8 例非致死性 MI（2.7%）、8 例非致死性卒中和 11 例心力衰竭住院（3.8%）。
在接受 CRT 以疑似 MCD 的女性中，与这些女性的 MACE 发生率相比，现代检测的风险相对较低。这些结果支持经验丰富的操作人员使用 CRT 对高危人群进行明确诊断和评估预后。（女性缺血综合征评估[WISE]；NCT00832702）。
