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50 Ischaemia and No Obstructive Coronary Artery Disease (INOCA): prevalence and predictors of coronary vasomotion disorders
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  1. Tom Ford1,
  2. Richard Good2,
  3. Paul Rocchiccioli3,
  4. Margaret McEntegart3,
  5. Stuart Watkins3,
  6. Hany Eteiba3,
  7. Aadil Shaukat3,
  8. Mitchell Lindsay3,
  9. Keith Robertson3,
  10. Stuart Hood3,
  11. Ross McGeoch4,
  12. Robert McDade3,
  13. Eric Yii5,
  14. Novalia Sidik5,
  15. Peter McCartney5,
  16. David Corcoran5,
  17. Damien Collison3,
  18. Christopher Rush5,
  19. Naveed Sattar5,
  20. Keith Oldroyd3,
  21. Rhian Touyz1,
  22. Colin Berry6
  1. 1University of Glasgow
  2. 2NHS NWTC
  3. 3West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, UK
  4. 4University Hospital Hairmyres, East Kilbride, Uk
  5. 5British Heart Foundation Glasgow Cardiovascular Research Centre
  6. 6NHS Greater Glasgow & Clyde

Abstract

Background Ischemia and no obstructive epicardial coronary artery disease (INOCA) is a common clinical syndrome with distinct underlying causes.

Objective To evaluate the prevalence and predictors of microvascular and/or vasospastic angina (MVA/VSA) in an unselected cohort of angina patients referred for invasive coronary angiography with suspected ischaemic heart disease in whom obstructive coronary artery disease (CAD) is excluded.

Methods Prospective cohort study at two regional centres between November 2016 and December 2017 including patients with symptoms and/or signs of ischaemia prior to undergoing invasive coronary angiography (NCT03193294). Baseline risk was assessed (ASSIGN score) and validated questionnaires were completed prior to the angiogram including Rose angina, quality of life (EuroQOL [EQ-5D-5L]) and angina severity according to the Seattle Angina Questionnaire (SAQ). Patients with definite or probable angina without CAD [diameter stenosis <50% and/or FFR > 0.80] proceeded directly to assessment for disorders of coronary vasomotion. This involved an ad hoc interventional diagnostic procedure (IDP) using reference invasive tests for microvascular angina (MVA), vasospastic angina (VSA), both conditions or none. MVA and VSA groups were compared before logistic regression was performed to assess predictors of MVA and VSA.

Results Three hundred and ninety-one patients with angina were recruited before undergoing invasive coronary angiography during the study period. Overall, 185 (47%) of subjects had INOCA and 151 of these underwent an IDP. INOCA patients reported similar angina burden with worse quality of life than CAD subjects (EQ5D-5L index 0.60 v 0.65 units; P=0.041). The mean age of patients who underwent the IDP was 60.9 years, 74% were female and their median predicted 10-year IHD risk was 18.6% (10.6, 31.4). 78 subjects (52%) had isolated microvascular angina, 25 (17%) had isolated vasospastic angina, 31 (20%) had both (MVA & VSA) only 17 (11%) had non-cardiac chest pain. Myocardial bridging of coronary artery was found in 22 (15%). Multivariate predictors of MVA included typical angina, inducible ischaemia but traditional cardiovascular risk factors were not associated. Smoking and age were independent predictors of VSA.

Abstract 50 Figure 1

Prevalence of coronary vasomotion disorders as revealed by the IDPThe underlying abnormalities revealed by the IDP included: isolated microvascular angina (MVA) in 78 (51.7%), isolated vasospastic angina (VSA) in 25 (16.6%), mixed MVA/VSA in 31 (20.5%), and non-cardiac chest pain in 17 (11.3%); (figure 2). Myocardial bridging was noted in 22 (15%) of subjects.

Abstract 50 Figure 2

Differences in baseline characteristics (A) and quality of life (B)between MVA & VSA groups.A - There were important key differences in baseline demographics notably a higher prevalence of dyslipidaemia (85% in MVA v 65% VSA) whereas smoking was more prevalent in the VSA group (36% VSA v 12% in MVA) MVA patients were more likely to have inducible ischaemia on ETT with a trend towards more typical exertional symptoms (Definite/typical defined by Rose Angina questionnaire).B - Angina severity and quality of life was worse in VSA compared to MVA subjects.

Conclusion The majority of patients with symptoms and/or signs of ischemia and no obstructive disease have a diagnosis of microvascular and/or vasospastic angina. Traditional cardiovascular risk scores have limited discrimination for disorders of coronary vasomotion.

Conflict of Interest Nil

  • Coronary vasomotion disorders
  • Vasospastic angina
  • Microvascular angina

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