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. 2021 Mar 22;14(6):606-618.
doi: 10.1016/j.jcin.2020.12.025.

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

Kensuke Nishimiya  1 , Akira Suda  1 , Kento Fukui  1 , Kiyotaka Hao  1 , Jun Takahashi  1 , Yasuharu Matsumoto  1 , Kiyoto Mitsuishi  1 , Tasuku Watanabe  1 , Kazuma Ohyama  1 , Jun Sugisawa  1 , Satoshi Tsuchiya  1 , Koichi Satoh  1 , Tomohiko Shindo  1 , Shigeo Godo  1 , Yoku Kikuchi  1 , Takashi Shiroto  1 , Satoshi Yasuda  1 , Hiroaki Shimokawa  2
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Free article

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

Kensuke Nishimiya et al. JACC Cardiovasc Interv. .
Free article

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.

Keywords: INOCA; OCT; coronary microvascular dysfunction; spasm; vasa vasorum.

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Conflict of interest statement

Funding Support and Author Disclosures This work was supported in part by grants-in-aid (to Dr. Nishimiya) for Scientific Research (19K17511). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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