Crooijmans Caïa, Jansen Tijn P J, Meeder Joan G, Woudstra Janneke, Meuwissen Martijn, De Vos Annemiek M J, Paradies Valeria, Olde Bijvank Els G M, Winkler Patty, Vos Nicola S, Arkenbout Karin, Woudstra Pier, Stoel Martin G, Van de Hoef Tim P, Van den Oord Stijn C H, Widdershoven Jos W M G, Remkes Wouter, Cetinyurek-Yavuz Aysun, Den Ruijter Hester M, Onland-Moret N Charlotte, Boersma Eric, Beijk Marcel A M, Appelman Yolande, Piek Jan J, Konst Regina E, Maas Angela H E M, Van Royen Niels, Dimitriu-Leen Aukelien C, Elias-Smale Suzette E, Damman Peter
Department of Cardiology Radboudumc, Nijmegen, the Netherlands.
Department of Cardiology VieCuri Medical Center, North Limburg, the Netherlands.
JAMA Cardiol. 2025 Apr 1;10(4):384-390. doi: 10.1001/jamacardio.2024.5670.
Patients with angina and no obstructive coronary artery disease frequently have coronary vasomotor dysfunction as underlying pathophysiological mechanism, comprising epicardial spasm, microvascular spasm, and/or microcirculatory dysfunction. These endotypes can be diagnosed by invasive coronary function testing which has previously shown to be safe in tertiary and expert centers.
To determine the prevalence of vasomotor dysfunction in patients with angina and no obstructive coronary artery disease who were clinically referred for a coronary function test (CFT); and assess safety and feasibility of a CFT.
DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study was performed using the Netherlands Registry of Invasive Coronary Vasomotor Function Testing (NL-CFT), a prospective, observational registry, in 15 participating hospitals (2 tertiary and 13 nontertiary). Patients with angina and no obstructive coronary artery disease who were referred for a clinically indicated CFT between December 2020 and January 2024 were included.
A complete CFT consisted of acetylcholine spasm provocation testing and assessment of microcirculatory function. Prevalence of different endotypes based on test results and overall safety were assessed.
Among a total of 1207 patients included, 978 (81%) were female; and the mean (SD) age was 60 (10) years. The prevalence of coronary vasomotor dysfunction was very high (78%). There were 11 (0.9%) major and 10 (0.8%) minor complications reported. Of them, 3 major and all minor were definitely related to the coronary function test. No procedural death, myocardial infarction, or stroke was observed. No differences were found in the occurrence of complications between tertiary and nontertiary centers.
This study found that a CFT was feasible and safe to perform in both tertiary and nontertiary centers with a high diagnostic yield.
患有心绞痛且无阻塞性冠状动脉疾病的患者，其潜在病理生理机制通常为冠状动脉血管舒缩功能障碍，包括心外膜痉挛、微血管痉挛和/或微循环功能障碍。这些亚型可通过侵入性冠状动脉功能测试进行诊断，此前已证明该测试在三级及专业中心是安全的。
确定临床转诊接受冠状动脉功能测试（CFT）的心绞痛且无阻塞性冠状动脉疾病患者中血管舒缩功能障碍的患病率；并评估CFT的安全性和可行性。
设计、设置和参与者：本质量改进研究使用荷兰侵入性冠状动脉血管舒缩功能测试注册库（NL-CFT）进行，该注册库为前瞻性观察性注册库，涉及15家参与医院（2家三级医院和13家非三级医院）。纳入了2020年12月至2024年1月期间因临床需要转诊接受CFT的心绞痛且无阻塞性冠状动脉疾病患者。
完整的CFT包括乙酰胆碱痉挛激发试验和微循环功能评估。根据测试结果评估不同亚型的患病率和总体安全性。
在总共纳入的1207例患者中，978例（81%）为女性；平均（标准差）年龄为60（10）岁。冠状动脉血管舒缩功能障碍的患病率非常高（78%）。报告了11例（0.9%）严重并发症和10例（0.8%）轻微并发症。其中，3例严重并发症和所有轻微并发症肯定与冠状动脉功能测试有关。未观察到手术死亡、心肌梗死或中风。三级医院和非三级医院之间并发症的发生率没有差异。
本研究发现，在三级医院和非三级医院进行CFT都是可行且安全的，诊断率很高。
