Safety of coronary reactivity testing in women with no obstructive coronary artery disease: results from the NHLBI-sponsored WISE (Women's Ischemia Syndrome Evaluation) study

Abstract

Objectives: 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).

Background: 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.

Methods: 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.

Results: 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%).

Conclusions: 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).

Conflict of interest statement

Disclosure: There are no relevant conflicts of interest of any of the authors to disclose.

Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1. Example Doppler Wire Tracing

Figure depicts coronary flow velocity map showing an average peak velocity of 39 and a coronary flow reserve of 2.8 in response to adenosine, as determined by a Doppler flow wire in the coronary artery. Adenosine tests non-endothelial dependent microvascular vasodilatory capacity. Coronary blood flow is calculated based on the change in diameter of the vessel and change in velocity in response to acetylcholine. Acetylcholine tests endothelial-dependent vasomotor function.

Figure 2. Coronary angiogram and Coronary Reactivity Testing

Figure shows Doppler flow wire in the left anterior descending artery (red arrow) (A). In response to acetylcholine infusion, there is abnormal coronary artery vasoconstriction (black arrows), indicating endothelial dysfunction (B). This is resolved by IC nitroglycerin (C).