Log in to MyACC
Coronary Reactivity and Adverse Outcomes in Women
Study Questions:
What is the association of coronary reactivity (CR) and longer-term adverse cardiovascular outcomes in women with and without obstructive coronary artery disease (CAD)?
Methods:
The investigators studied women with signs and symptoms of ischemia who were enrolled in the WISE (Women’s Ischemia Syndrome Evaluation) study from 1996 to 2000, as previously described. Women (n = 224) with signs and symptoms of ischemia underwent CR testing. Coronary flow reserve and coronary blood flow were obtained to test microvascular function, whereas epicardial CR was tested by coronary dilation response to intracoronary (IC) acetylcholine and IC nitroglycerin. All-cause mortality, major adverse cardiovascular events (MACE) (cardiovascular death, myocardial infarction, stroke, and heart failure), and angina hospitalizations served as clinical outcomes over a median follow-up of 9.7 years.
Results:
The authors identified 129 events during the follow-up period. Low coronary flow reserve was a predictor of increased MACE rate (hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.01-1.12; p = 0.021), whereas low coronary blood flow was associated with increased risk of mortality (HR, 1.12; 95% CI, 1.01-1.24; p = 0.038) and MACE (HR, 1.11; 95% CI, 1.03-1.20; p = 0.006) after adjusting for cardiovascular risk factors. In addition, a decrease in cross-sectional area in response to IC acetylcholine was associated with a higher hazard of angina hospitalization (HR, 1.05; 95% CI, 1.02-1.07; p < 0.0001). There was no association between epicardial IC nitroglycerin dilation and outcomes.
Conclusions:
The authors concluded that on longer-term follow-up, impaired microvascular function predicts adverse cardiovascular outcomes in women with signs and symptoms of ischemia.
Perspective:
This study reports that impaired endothelium and non–endothelium-dependent coronary microvascular reactivity predict adverse cardiovascular events among women with signs and symptoms of ischemia. Furthermore, abnormal response to endothelium-dependent pathways in the microvasculature predicts increased mortality on long-term follow-up when adjusted for various cardiovascular risk factors. These findings highlight the need for identifying patients with an objective cause for symptoms of angina such as abnormal CR, and to appropriately follow and treat these patients to improve survival and avoid recurrent hospitalizations. Since CR testing is an invasive procedure that requires experienced operators, additional research is indicated to develop noninvasive and cost-effective strategies to assess CR in clinical practice.
Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Atherosclerotic Disease (CAD/PAD), Acute Heart Failure
Keywords: Acetylcholine, Angina Pectoris, Coronary Artery Disease, Dilatation, Endothelium, Heart Failure, Metabolic Syndrome, Microvessels, Myocardial Infarction, Myocardial Ischemia, Nitroglycerin, Risk Factors, Secondary Prevention, Stroke
< Back to Listings
