SPC365

Angina beyond structural coronary disease: Tailoring medical therapy using coronary function testing

Session: Comunicações Orais - Sessão 17 -Síndromes Coronárias Crónicas
Speaker: André Paulo Ferreira

Congress: CPC 2023
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 12. Coronary Artery Disease (Chronic)
Subtheme: 12.8 Coronary Artery Disease - Other
Session Type: Comunicações Orais
FP Number: ---
Authors: André Paulo Ferreira; Miguel Marques Antunes; Vera Ferreira; Tiago Mendonça; Tiago Pereira-Da-Silva; Hugo Rodrigues; Filipa Silva; Cristina Fondinho; Ana Santana; Rui Cruz Ferreira; Rúben Ramos

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Background: </span></span></strong><span style="font-size:11.0pt"><span style="color:black">Invasive coronary function testing (CFT) performed in patients with ischemia with no obstructive coronary artery disease (INOCA), is helpful in determining the mechanism of angina. However, it still is neither widely accepted nor applied in many medical centers.&nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Purpose: </span></span></strong><span style="font-size:11.0pt"><span style="color:black">The aim of this study was to test whether medical therapy guided by CFT improves angina symptoms of patients with INOCA in a real-world clinical environment.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Methods: </span></span></strong><span style="font-size:11.0pt"><span style="color:black">Patients with INOCA that underwent coronary function testing between July 2021 and October 2022 were included in this single-center prospective study. They were compared to a contemporary cohort of INOCA patients that underwent invasive coronary angiography (ICA) without function testing (Conv group). A standardized protocol was used in all patients in the CFT group and consisted of the assessment of fractional flow reserve, coronary flow reserve, index of microvascular resistance, and of provocative testing with acetylcholine. Coronary vasomotion disorders were diagnosed based on the criteria proposed by the Coronary Vasomotor Disorders International Study Group. Medical therapy was tailored for the final diagnosis in the CFT group. The study&rsquo;s primary endpoint was angina symptoms variation from the baseline as assessed by the Canadian Cardiovascular Society Score (CCS).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Results:</span></span></strong><strong> </strong><span style="font-size:11.0pt"><span style="color:black">A total of 56 CFTs were performed in the CFT group during the study period. Patient mean age was 64&plusmn;12 years and 57.1% were female. A total of 111 standard ICAs were performed in the Conv group. There were no significant differences between the groups&rsquo; demographics. In the CFT group, isolated epicardial vasospasm was found in 16 (28.6%) patients, isolated coronary microvascular dysfunction (CMD) in 9 (16.1%), and a combination of CMD and coronary vasospasm in 9 (16.1%) patients. Only 1 patient (1.8%) had isolated microvascular spasm. The intervention in the CFT group resulted in a modification to previously instituted medical therapy in 64.3% of patients at discharge, resulting in a significant reduction in the Canadian Cardiovascular Society Score (-1.04&plusmn;0.80 U in the CFT group vs -0.13&plusmn;0.42 U in the Conv group, p&lt;;0.001) at 3 months. After a median follow-up time of 6 months, major adverse cardiac events were similar between both groups (1.8% CFT group vs 2.9% Conv group, p=0.664).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Conclusion: </span></span></strong><span style="font-size:11.0pt"><span style="color:black">An invasive, standardized, multi-parametric protocol for the evaluation of coronary vasomotion disorders is feasible and safe in clinical practice, and allows for individualized medical therapy, which may improve angina symptoms in INOCA patients at a short-term follow-up.</span></span></span></span></p>