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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function

Published on: March 15, 2022

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Prognostic stratification of patients with nonobstructive coronary artery disease managed according to invasive

Eva Rumiz1, Georgina Fuertes2, Ainhoa Pérez3

  • 1Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Universitat de València, Valencia, Spain; Servicio de Cardiología, Hospital QuironSalud, Valencia, Spain.

Revista Espanola De Cardiologia (English Ed.)
|November 27, 2025
PubMed

Insights

Patients with angina or myocardial ischemia with nonobstructive coronary artery disease (ANOCA/INOCA) have different prognoses based on their endotype. Microvascular dysfunction is linked to a higher risk of adverse cardiovascular events, even with tailored therapy.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Translational Research

Background:

  • Angina or myocardial ischemia with nonobstructive coronary artery disease (ANOCA/INOCA) presents a diagnostic challenge and is associated with adverse outcomes.
  • Understanding the prognostic implications of different ANOCA/INOCA endotypes is crucial for guiding patient management.

Purpose of the Study:

  • To evaluate the long-term prognosis of patients with ANOCA/INOCA stratified by endotype identified through invasive coronary function testing (CFT).
  • To determine if tailored therapy based on endotype influences patient outcomes.

Main Methods:

  • Prospective, multicenter observational study involving 308 ANOCA/INOCA patients undergoing invasive CFT.
  • Patients were classified into four endotypes: microvascular dysfunction, epicardial spasm, microvascular spasm, and negative-CFT.
  • Primary outcome was a composite of myocardial infarction, emergency department visits for chest pain, or hospital admissions for angina/heart failure, analyzed using negative binomial regression.

Main Results:

  • Over a median follow-up of 1.8 years, significant differences in the composite outcome incidence rates were observed across endotypes (P < .001).
  • Microvascular dysfunction demonstrated the highest incidence rate of adverse events (35.3 per 100 patient-years).
  • Multivariable analysis identified microvascular dysfunction as the sole independent predictor of the composite outcome (IRR, 3.24; P=.029).

Conclusions:

  • Endotype classification in ANOCA/INOCA patients reveals distinct prognostic trajectories despite tailored medical therapy.
  • Microvascular dysfunction represents a high-risk endotype associated with a greater burden of recurrent cardiovascular events.
Abstract

Keywords:
Chronic coronary syndromeCoronary flow reserveDisfunción microvascularEnfermedad coronaria no obstructivaMicrovascular dysfunctionNonobstructive coronary artery diseaseReserva de flujo coronarioSíndrome coronario crónico

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