New Research Paper
Coronary
Prognostic Links Between OCT-Delineated Coronary Morphologies and Coronary Functional Abnormalities in Patients With INOCA

https://doi.org/10.1016/j.jcin.2020.12.025Get rights and content
Under a Creative Commons license
open access

Abstract

Objectives

Whether there are prognostic links between coronary morphologies and coronary functional abnormalities was examined in ischemia and nonobstructive coronary artery disease (INOCA) patients.

Background

Although INOCA has attracted much attention, little is known about the prognostic impact of coronary morphologies in this disorder.

Methods

A total of 329 consecutive INOCA patients were enrolled and underwent spasm provocation testing combined with lactate sampling for diagnosis of epicardial and microvascular spasm (MVS). On the basis of the functional tests, the patients were classified into 4 groups: a control group without epicardial spasm or MVS (n = 32), MVS alone (n = 51), diffuse spasm in ≥2 coronary segments (n = 204), and focal spasm in 1 segment (n = 42). In this population, optical coherence tomography imaging of the left anterior descending coronary artery was performed for evaluation of adventitial vasa vasorum (AVV) and intraplaque neovessels (IPN). Index of microcirculatory resistance was also measured.

Results

MVS frequently coexisted with diffuse (70%) and focal spasm (68%) with a good correlation between AVV and index of microcirculatory resistance (R = 0.353; p = 0.022). For a median follow-up of 1,043 days, focal spasm showed the worst prognosis (log rank p = 0.005), for which IPN was a significant prognostic factor. By contrast, diffuse spasm showed the greatest AVV with an intermediate prognosis. The prognostic value of INOCA was significantly enhanced by adding AVV and IPN to the physiological indices (area under the curve = 0.88 vs. 0.76; p = 0.048).

Conclusions

These results provide the first evidence that there are important prognostic links between coronary morphologies (evaluated by optical coherence tomography) and coronary functional abnormalities in patients with INOCA, indicating the importance of both evaluations in this population.

Key Words

coronary microvascular dysfunction
INOCA
OCT
spasm
vasa vasorum

Abbreviations and Acronyms

AVV
adventitial vasa vasorum
CMD
coronary microvascular dysfunction
FFR
fractional flow reserve
LAD
left anterior descending coronary artery
IMR
index of microcirculatory resistance
INOCA
ischemia and no obstructive coronary artery disease
MACE
major adverse cardiac event(s)
MVS
microvascular spasm
OCT
optical coherence tomography

Cited by (0)

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.