Prevalence and Characteristics of INOCA in Patients With Either Angiographically Normal Vessels or Non-Obstructive
Adrián Jerónimo1, José G Paredes-Vázquez1, Marco Lombardi1
1Department of Cardiology, Hospital Clinico San Carlos IDISSC, CIBER-CV and Universidad Complutense de Madrid, Madrid, Spain.
Insights
Myocardial ischemia of non-obstructive origin (INOCA) affects patients with and without coronary atherosclerosis similarly. Functional coronary testing is crucial for diagnosing INOCA, regardless of atherosclerosis presence.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Myocardial ischemia of non-obstructive origin (INOCA) is a common cause of chronic coronary syndromes (CCS).
- Atherosclerosis risk factors may also contribute to INOCA, prompting investigation into their clinical relationship.
- The AID-ANGIO trial provides a platform for this sub-analysis.
Purpose of the Study:
- To compare the prevalence and clinical characteristics of INOCA in patients with and without coronary atherosclerosis.
- To determine if coronary atherosclerosis influences the presentation or diagnosis of INOCA.
- To identify factors associated with INOCA endotypes.
Main Methods:
- Sub-analysis of the prospective, multicentre AID-ANGIO study.
- Coronary angiography and pressure guidewires used to assess obstructive coronary artery disease (CAD).
- Functional coronary testing (FCT) performed for patients without obstructive-CAD; INOCA patients classified as INOCA-Ath (non-obstructive atherosclerosis) or INOCA-NoAth (normal coronary arteries).
Main Results:
- Prevalence of INOCA-Ath (78.7%) and INOCA-NoAth (70.2%) was similar.
- Patient symptoms, ischemia test results, and endotype distribution were comparable between groups.
- Vasomotor abnormalities were the most frequent finding in both INOCA-Ath (81.4%) and INOCA-NoAth (74.0%) groups.
Conclusions:
- INOCA prevalence is similar in patients with and without non-obstructive coronary atherosclerosis.
- Clinical features and endotype distribution of INOCA do not significantly differ based on the presence of atherosclerosis.
- Functional coronary testing is essential for accurate INOCA diagnosis.
Background:
Myocardial ischemia of non-obstructive origin (INOCA) is a prevalent cause of chronic coronary syndromes (CCS). Risk factors for atherosclerosis have also been described to promote INOCA, raising the question whether these entities are clinically related.
Aims:
Our aim was to compare the prevalence and clinical characteristics of INOCA in patients with and without coronary atherosclerosis.
Methods:
Sub-analysis of the all-comers, prospective, multicentre AID-ANGIO study, enrolling consecutive CCS patients, referred for coronary angiography. Obstructive coronary artery disease (CAD) was investigated by angiography and pressure guidewires. In the absence of obstructive-CAD, functional coronary testing (FCT) was performed within the same procedure. All patients diagnosed with INOCA were classified according to the evidence of non-obstructive atherosclerosis (INOCA-Ath) or the presence of angiographically normal coronary arteries (INOCA-NoAth).
Results:
In the AID ANGIO study, 89 patients presented non-obstructive coronary atherosclerosis and 104 had angiographically normal coronary arteries. Prevalence of INOCA-Ath and INOCA-NoAth was 78.7% and 70.2%, respectively (p = 0.181). Patients' symptoms, results from ischemia tests and endotype distribution were comparable in both groups. Vasomotor abnormalities were the most frequently identified (81.4% INOCA-Ath vs. 74.0% INOCA-NoAth; p = 0.285). INOCA endotype was not predicted by the presence of coronary atherosclerosis, typical anginal symptoms, a positive ischemia test or atherogenic risk factors, whereas a youger age was associated with vasomotor disorders.
Conclusions:
In an all-comers population of patients with CCS, prevalence of INOCA was similar in patients with and without non-obstructive CAD. Clinical features and endotype distribution were also comparable, highlighting the need for FCT to make a correct diagnosis.
Trial Registration:
The present study was conducted as a sub-analysis of the AID-ANGIO trial (ClinicalTrials.gov NCT056359949).
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