Yale New Haven Hospital New Haven New Haven CT.
Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT.
J Am Heart Assoc. 2024 Oct;13(19):e035852. doi: 10.1161/JAHA.124.035852. Epub 2024 Sep 18.
Approximately 50% of women referred for invasive coronary angiography have angina and nonobstructive coronary arteries, which includes coronary microvascular dysfunction, vasospastic angina, and other vasomotor disorders. We sought to determine the real-world diagnostic yield of invasive coronary angiography and coronary function testing in women with angina and nonobstructive coronary arteries.
From 2018 to 2023, we enrolled 198 women who underwent either coronary angiography (CA) alone (n=99) or coronary function testing (CFT; n=99). Mean±SD age was 62±10 years (CA alone) compared with 57±10 years (CFT). Coronary angiography was interpreted as nonobstructive coronary artery disease more frequently after CA alone (79% versus 52%). Of the women who underwent CFT, 82% (N=81) were found to have vasomotor disorders, including coronary microvascular dysfunction (27%), vasospastic angina (32%), mixed coronary microvascular dysfunction/vasospastic angina (16%), endothelial dysfunction (10%; without spasm), elevated resting flow (2%), or symptomatic myocardial bridging (4%). Compared with women undergoing CA alone, medications were changed more frequently after CFT at 24 hours (41% versus 65%; =0.001) and between 24 hours and 30 days (30% versus 44%; =0.04) with intensification of antianginal therapy (79% versus 92%; 0.0001) and increased use of calcium channel blockers (36% versus 63%; 0.0001).
Our findings demonstrate that women presenting with suspected ischemic heart disease undergoing CA alone only received an anatomic diagnosis, whereas >80% of women undergoing CFT received a specific diagnosis of a coronary vasomotor disorder and greater intensification of antianginal therapy.
约有 50%因疑似缺血性心脏病而行有创冠状动脉造影检查的女性患者其冠状动脉无明显狭窄，包括冠状动脉微血管功能障碍、痉挛性心绞痛和其他血管舒缩功能障碍。我们旨在确定在有症状且冠状动脉无明显狭窄的女性患者中行有创冠状动脉造影检查和冠状动脉功能检查的实际诊断效果。
在 2018 年至 2023 年期间，我们纳入了 198 名女性患者，其中 99 名患者仅接受了冠状动脉造影检查（CA 组），99 名患者接受了冠状动脉功能检查（CFT 组）。CA 组的平均年龄为 62±10 岁，CFT 组为 57±10 岁。CA 组冠状动脉造影检查结果为非阻塞性冠心病的比例更高（79% 比 52%）。行 CFT 的患者中，82%（81 名）存在血管舒缩功能障碍，包括冠状动脉微血管功能障碍（27%）、痉挛性心绞痛（32%）、混合性冠状动脉微血管功能障碍/痉挛性心绞痛（16%）、内皮功能障碍（10%；无痉挛）、静息血流升高（2%）或有症状性心肌桥（4%）。与仅行 CA 的女性患者相比，CFT 后 24 小时（41%比 65%；=0.001）和 24 小时至 30 天（30%比 44%；=0.04）药物改变更频繁，抗心绞痛治疗强化（79%比 92%；0.0001）和钙通道阻滞剂使用增加（36%比 63%；0.0001）。
我们的研究结果表明，因疑似缺血性心脏病而行 CA 的女性患者仅获得解剖学诊断，而＞80%行 CFT 的女性患者获得了冠状动脉血管舒缩功能障碍的明确诊断，并接受了更强化的抗心绞痛治疗。
