Refractory angina in women with ischemia and no obstructive coronary artery disease — A report from the Women’s Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study
Background: Women with suspected ischemia and no obstructive coronary artery disease (INOCA) are often challenging to manage. We aimed to understand mechanisms and treatable pathways of refractory angina. Methods: The Women's Ischemia Syndrome Evaluation – Coronary Vascular Dysfunction (NCT0083...
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| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-06-01
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| Series: | American Heart Journal Plus |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666602225000503 |
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| Summary: | Background: Women with suspected ischemia and no obstructive coronary artery disease (INOCA) are often challenging to manage. We aimed to understand mechanisms and treatable pathways of refractory angina. Methods: The Women's Ischemia Syndrome Evaluation – Coronary Vascular Dysfunction (NCT00832702) recruited women between 2008 and 2015. In a pre-defined subgroup (n = 198) with repeat cardiac magnetic resonance imaging (CMRI) at 1-year, we investigated severity of angina (Seattle Angina Questionnaire-7) in relation to risk factors, baseline invasive coronary function testing, and CMRI parameters. Refractory angina was defined as SAQ-7 score < 75 at baseline and < 10-point improvement at 1-year. Results: Women with refractory angina (n = 60, 30 %), compared to those without, had lower incomes, and higher proportion of hypertension and nitrate use at 1-year (p < 0.05). They also had significantly lower baseline coronary blood flow (CBF) response to acetylcholine (p < 0.01). Myocardial perfusion reserve index was not different at baseline or follow-up. At 1-year, changes in SAQ domain scores significantly differed between groups, with persistent lack of improvement in physical limitation, disease perception, angina stability, and angina frequency (p < 0.05) in the refractory group. In an age-adjusted regression model, hypertension (OR 4.48; 95 % CI 1.23–16.25; p = 0.02) and abnormal CBF (OR 3.34; 95 % CI 1.04–10.72; p = 0.04) were associated with refractory angina. Conclusions: Refractory angina is common in women with INOCA. Hypertension and endothelial-dependent microvascular dysfunction are independently associated with a 4- and 3-fold increase in refractory angina at 1-year, respectively. These findings may identify potential treatment targets to reduce angina burden in INOCA. |
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| ISSN: | 2666-6022 |