Invasive Coronary Function Testing in Patients With Prior PCI Who Have Persistent ANOCA

Area of Science:

• Cardiology
• Interventional Cardiology
• Diagnostic Imaging

Background:

• Managing post-percutaneous coronary intervention (PCI) angina presents challenges.
• Comprehensive coronary function testing (CFT) can detect occult coronary abnormalities in patients with angina and nonobstructive coronary arteries.
• The utility of CFT in patients with post-PCI persistent angina and no obstructive coronary artery disease remains unexplored.

Purpose of the Study:

• To assess the diagnostic yield and therapeutic implications of comprehensive coronary function testing (CFT) in patients experiencing persistent angina after percutaneous coronary intervention (PCI) despite non-obstructive coronary artery disease.
• To evaluate the prevalence of various coronary abnormalities, including endothelial dysfunction, epicardial and microvascular spasm, low fractional flow reserve, coronary microvascular dysfunction, and myocardial bridging, in this patient population.
• To determine the impact of CFT-guided management on symptom severity and quality of life.

Main Methods:

• A cohort of 46 patients with prior PCI and persistent angina underwent comprehensive coronary function testing (CFT).
• CFT included assessments for endothelial dysfunction, epicardial and microvascular spasm, fractional flow reserve (FFR), coronary microvascular dysfunction, and myocardial bridging using intravascular ultrasound.
• Symptom severity and quality of life were measured using the Seattle Angina Questionnaire before and 1-year after CFT.

Main Results:

• The study included 46 patients (63% women, median age 60 years) with severe anginal symptoms and poor quality of life.
• CFT revealed a median FFR of 0.84, with 19.6% having FFR ≤0.8. Endothelial dysfunction was found in 36.9%, epicardial spasm in 56.5%, microvascular spasm in 17.4%, coronary microvascular dysfunction in 43.5%, and myocardial bridging in 63%.
• Patients reported significant improvement in Seattle Angina Questionnaire scores 1-year post-CFT, indicating better symptom control and quality of life.

Conclusions:

• Patients with post-PCI persistent angina often have significant underlying coronary abnormalities, including endothelial dysfunction, spasm, and myocardial bridging.
• Comprehensive CFT is valuable for diagnosing the cause of persistent angina in these challenging patients.
• CFT-guided therapy can lead to improved symptoms and quality of life in patients with post-PCI angina.