Log in to MyACC
Ischemia With Nonobstructive Coronary Arteries
Quick Takes
- In patients with at least moderate ischemia, 13% may have nonobstructive atherosclerosis.
- Ischemia with nonobstructive coronary arteries (INOCA) is more common in younger patients and females (OR, 4.2; 95% CI, 3.4-5.2); however, suspicion of INOCA is needed in all patients, as 46% of this cohort were male.
Study Questions:
What is the prevalence of ischemia with nonobstructive coronary arteries (INOCA) among patients with at least moderate ischemia? And what is the relationship between ischemia and nonobstructive atherosclerosis?
Methods:
Coronary computed tomography angiography (CCTA) and other noninvasive stress tests (nuclear imaging, echocardiography, magnetic resonance imaging, or nonimaging exercise tolerance testing) were reviewed by core laboratories. INOCA was defined as all stenoses <50% on CCTA in patients with moderate or severe ischemia on stress testing.
Results:
INOCA was present in 476 (13%) of the 3,612 participants with moderate or severe ischemia and interpretable CCTA. INOCA was associated with younger age, female sex, and fewer traditional cardiovascular risk factors. The extent of ischemia tended to be less among patients with INOCA, but there was no significant relationship between severity of ischemia and the extent of nonobstructive atherosclerosis on CCTA. Compared with men, women had an odds ratio (OR) of 4.2 (95% confidence interval [CI], 3.4-5.2) for INOCA.
Conclusions:
In the ISCHEMIA study cohort, INOCA prevalence was 13% among those with moderate or severe ischemia. The severity of nonobstructive atherosclerosis was not associated with the severity of ischemia.
Perspective:
INOCA is encountered on a regular basis in clinical practice; unfortunately, some patients may be incorrectly told that the absence of obstructive stenoses on CCTA is reassuring and the stress test was a false-positive result. This study shows that a significant proportion of patients with INOCA may have moderate or severe ischemia, as confirmed by core laboratory assessment. Younger women are more likely to have INOCA, yet a substantial proportion of those with INOCA are male (46%). Clinicians need to have high suspicion of this diagnosis in order to properly treat and care for these patients. Optimal medical treatment and lifestyle measures for treatment of INOCA remain to be determined.
Clinical Topics: Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Computed Tomography, Echocardiography/Ultrasound, Magnetic Resonance Imaging, Nuclear Imaging
Keywords: Angiography, Atherosclerosis, Coronary Angiography, Computed Tomography Angiography, Coronary Artery Disease, Diagnostic Imaging, Echocardiography, Exercise Test, Ischemia, Myocardial Ischemia, Magnetic Resonance Imaging, Risk Factors
< Back to Listings
