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

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• 作者：Janet Wei ; MD^?/sup> ; Puja K. Mehta ; MD^?/sup> ; B. Delia Johnson ; PhD^&dagger ; ; Bruce Samuels ; MD^?/sup> ; Saibal Kar ; MD^&Dagger ; ; R. David Anderson ; MD^§ ; ; Babak Azarbal ; MD^&Dagger ; ; John Petersen ; MD^§ ; ; Barry Sharaf ; MD^?/sup> ; Eileen Handberg ; PhD^§ ; ; Chrisandra Shufelt ; MD^?/sup> ; Kamlesh Kothawade ; MBBS^?/sup> ; George Sopko ; MD^¶ ; ; Amir Lerman ; MD^# ; Leslee Shaw ; PhD^?? ; Sheryl F. Kelsey ; PhD^&dagger ; ; Carl J. Pepine ; MD^§ ; ; C. Noel Bairey Merz ; MD^?/sup> ; ^{merz@cshs.org}
• 关键词：coronary reactivity ; endothelial dysfunction ; microvascular dysfunction
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2012
• 出版时间：June, 2012
• 年：2012
• 卷：5
• 期：6
• 页码：646-653
• 全文大小：739 K

文摘

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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]; )