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Ford TJ, Yii E, Sidik N, Good R, Rocchiccioli P, McEntegart M, Watkins S, Eteiba H, Shaukat A, Lindsay M, Robertson K, Hood S, McGeoch R, McDade R, McCartney P, Corcoran D, Collison D, Rush C, Stanley B, McConnachie A, Sattar N, Touyz RM, Oldroyd KG, Berry C. Ischemia and No Obstructive Coronary Artery Disease: Prevalence and Correlates of Coronary Vasomotion Disorders. Circ Cardiovasc Interv 2019; 12:e008126. [PMID: 31833416 PMCID: PMC6924940 DOI: 10.1161/circinterventions.119.008126] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/30/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Determine the prevalence and correlates of microvascular and vasospastic angina in patients with symptoms and signs of ischemia but no obstructive coronary artery disease (INOCA). METHODS Three hundred ninety-one patients with angina were enrolled at 2 regional centers over 12 months from November 2016 (NCT03193294). INOCA subjects (n=185; 47%) had more limiting dyspnea (New York Heart Association classification III/IV 54% versus 37%; odds ratio [OR], 2.0 [1.3-3.0]; P=0.001) and were more likely to be female (68% INOCA versus 38% in coronary artery disease; OR, 1.9 [1.5 to 2.5]; P<0.001) but with lower cardiovascular risk scores (ASSIGN score median 20% versus 24%; P=0.003). INOCA subjects had similar burden of angina (Seattle Angina Questionnaire) but reduced quality of life compared with coronary artery disease; subjects (EQ5D-5 L index 0.60 versus 0.65 units; P=0.041). RESULTS An interventional diagnostic procedure with reference invasive tests including coronary flow reserve, microvascular resistance, and vasomotor responses to intracoronary acetylcholine (vasospasm provocation) was performed in 151 INOCA subjects. Overall, 78 (52%) had isolated microvascular angina, 25 (17%) had isolated vasospastic angina, 31 (20%) had both, and 17 (11%) had noncardiac chest pain. Regression analysis showed inducible ischemia on treadmill testing (OR, 7.5 [95% CI, 1.7-33.0]; P=0.008) and typical angina (OR, 2.7 [1.1-6.6]; P=0.032) were independently associated with microvascular angina. Female sex tended to associate with a diagnosis of microvascular angina although this was not significant (OR, 2.7 [0.9-7.9]; P=0.063). Vasospastic angina was associated with smoking (OR, 9.5 [2.8-32.7]; P<0.001) and age (OR, 1.1 per year, [1.0-1.2]; P=0.032]. CONCLUSIONS Over three quarters of patients with INOCA have identifiable disorders of coronary vasomotion including microvascular and vasospastic angina. These patients have comparable angina burden but reduced quality of life compared to patients with obstructive coronary artery disease. Microvascular angina and vasospastic angina are distinct disorders that may coexist but differ in associated clinical characteristics, symptoms, and angina severity. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT03193294.
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Affiliation(s)
- Thomas J. Ford
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
- Department of Interventional Cardiology, Gosford Hospital, New South Wales, Australia (T.J.F.)
- University of New South Wales, Sydney, Australia (T.J.F.)
| | - Eric Yii
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Novalia Sidik
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Richard Good
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Paul Rocchiccioli
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Margaret McEntegart
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Stuart Watkins
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Hany Eteiba
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Aadil Shaukat
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Mitchell Lindsay
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Keith Robertson
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Stuart Hood
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Ross McGeoch
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- Department of Interventional Cardiology, University Hospital Hairmyres, East Kilbride, United Kingdom (R. McGeoch, N. Sattar)
| | - Robert McDade
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
| | - Peter McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - David Corcoran
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
- Department of Interventional Cardiology, Gosford Hospital, New South Wales, Australia (T.J.F.)
- University of New South Wales, Sydney, Australia (T.J.F.)
- Department of Interventional Cardiology, University Hospital Hairmyres, East Kilbride, United Kingdom (R. McGeoch, N. Sattar)
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, United Kingdom (B.S., A.M.)
| | - Damien Collison
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Christopher Rush
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Bethany Stanley
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, United Kingdom (B.S., A.M.)
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, United Kingdom (B.S., A.M.)
| | - Naveed Sattar
- Department of Interventional Cardiology, University Hospital Hairmyres, East Kilbride, United Kingdom (R. McGeoch, N. Sattar)
| | - Rhian M. Touyz
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Keith G. Oldroyd
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
| | - Colin Berry
- Department of Interventional Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, United Kingdom (T.J.F., R.G., P.R., M.M., S.W., H.E., A.S., M.L., K.R., S.H., R.M., D. Collison., K.G.O., C.B.)
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.F., E.Y., N. Sidik., P.R., M.M., P.M., D. Collison, C.R., R.M.T., K.G.O., C.B.)
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