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Testing Acetylcholine Followed by Adenosine for Invasive Diagnosis of Coronary Vasomotor Disorders
Published on: February 3, 2021
Safety, Feasibility, and Diagnostic Yield of Invasive Coronary Function Testing: Netherlands Registry of Invasive
Caïa Crooijmans1, Tijn P J Jansen1, Joan G Meeder2
1Department of Cardiology Radboudumc, Nijmegen, the Netherlands.
Insights
Coronary vasomotor dysfunction is common in angina patients without obstructive coronary artery disease. Coronary function testing (CFT) is a safe and feasible diagnostic tool for identifying this condition across various hospital settings.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Testing
Background:
- Coronary vasomotor dysfunction (CVD) is a frequent cause of angina in patients with non-obstructive coronary artery disease.
- Diagnosing CVD typically involves invasive coronary function testing (CFT), which has been considered safe in expert centers.
Purpose of the Study:
- To determine the prevalence of CVD in patients with angina and no obstructive coronary artery disease referred for CFT.
- To assess the safety and feasibility of performing CFT in a multicenter setting.
Main Methods:
- A prospective, observational registry (NL-CFT) collected data from 15 hospitals (2 tertiary, 13 nontertiary).
- Patients with angina and no obstructive coronary artery disease undergoing clinically indicated CFT between December 2020 and January 2024 were included.
- CFT involved acetylcholine spasm provocation and microcirculatory function assessment.
Main Results:
- A total of 1207 patients were included; 81% were female, mean age 60 years.
- The prevalence of coronary vasomotor dysfunction was high at 78%.
- The overall complication rate was low (0.9% major, 0.8% minor), with no deaths, myocardial infarctions, or strokes. Complication rates were similar between tertiary and nontertiary centers.
Conclusions:
- Coronary function testing is a feasible and safe procedure in both tertiary and nontertiary centers.
- CFT demonstrates a high diagnostic yield for identifying coronary vasomotor dysfunction in patients with angina and non-obstructive coronary artery disease.
Importance:
Patients with angina and no obstructive coronary artery disease frequently have coronary vasomotor dysfunction as underlying pathophysiological mechanism, comprising epicardial spasm, microvascular spasm, and/or microcirculatory dysfunction. These endotypes can be diagnosed by invasive coronary function testing which has previously shown to be safe in tertiary and expert centers.
Objective:
To determine the prevalence of vasomotor dysfunction in patients with angina and no obstructive coronary artery disease who were clinically referred for a coronary function test (CFT); and assess safety and feasibility of a CFT.
Design, Setting, And Participants:
This quality improvement study was performed using the Netherlands Registry of Invasive Coronary Vasomotor Function Testing (NL-CFT), a prospective, observational registry, in 15 participating hospitals (2 tertiary and 13 nontertiary). Patients with angina and no obstructive coronary artery disease who were referred for a clinically indicated CFT between December 2020 and January 2024 were included.
Main Outcomes And Measures:
A complete CFT consisted of acetylcholine spasm provocation testing and assessment of microcirculatory function. Prevalence of different endotypes based on test results and overall safety were assessed.
Results:
Among a total of 1207 patients included, 978 (81%) were female; and the mean (SD) age was 60 (10) years. The prevalence of coronary vasomotor dysfunction was very high (78%). There were 11 (0.9%) major and 10 (0.8%) minor complications reported. Of them, 3 major and all minor were definitely related to the coronary function test. No procedural death, myocardial infarction, or stroke was observed. No differences were found in the occurrence of complications between tertiary and nontertiary centers.
Conclusions And Relevance:
This study found that a CFT was feasible and safe to perform in both tertiary and nontertiary centers with a high diagnostic yield.
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