ANOCA Patients With Prior Obstructive Coronary Artery Disease and PCI Have Higher Odds of Epicardial Spasm.

BACKGROUND

Up to 50% of patients undergoing coronary angiography have angina with no obstructive coronary arteries (ANOCA). Among ANOCA patients, 2 distinct groups exist: patients with and without a history of prior obstructive coronary artery disease (CAD) treated with percutaneous coronary intervention (PCI).

OBJECTIVES

This study aims to evaluate associations between history of prior obstructive CAD treated with PCI and coronary microvascular and vasomotor dysfunction endotypes in ANOCA patients.

METHODS

A prospective Coronary Microvascular and Vasomotor Dysfunction Registry of consecutive ANOCA patients undergoing invasive coronary functional testing (ICFT).

RESULTS

Among 624 ANOCA patients undergoing ICFT, 11% had prior obstructive CAD treated with PCI. ANOCA patients with prior obstructive CAD had a higher prevalence of males, were older, and had higher rates of cardiovascular risk factors. Prior obstructive CAD treated with PCI was associated with an 11-point lower Seattle Angina Questionnaire 7 summary score in unadjusted (β -11.0; 95% CI: -17.0 to -4.4; P = 0.001) and adjusted models. Patients with prior obstructive CAD treated with PCI had a higher prevalence of epicardial spasm by angiographic criteria (70% vs 34%; P < 0.001) and 4.55-fold higher odds of epicardial spasm in unadjusted (OR: 4.55; 95% CI: 2.65-8.07; P < 0.001) and adjusted models, with similar odds of coronary microvascular dysfunction.

CONCLUSIONS

Among ANOCA patients, those with prior obstructive CAD treated with PCI had over a 4-fold higher odds of epicardial spasm. These findings underscore the need for comprehensive ICFT in ANOCA patients with prior PCI.