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Comparative Study
. 2024 May 13;17(9):1091-1102.
doi: 10.1016/j.jcin.2024.03.007.

Multivessel Coronary Function Testing Increases Diagnostic Yield in Patients With Angina and Nonobstructive Coronary Arteries

Rajan Rehan  1 , Christopher C Y Wong  2 , James Weaver  1 , William Chan  1 , Jennifer A Tremmel  2 , William F Fearon  1 , Martin K C Ng  1 , Andy S C Yong  3
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Free article
Comparative Study

Multivessel Coronary Function Testing Increases Diagnostic Yield in Patients With Angina and Nonobstructive Coronary Arteries

Rajan Rehan et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: Invasive CFT is the gold standard for diagnosing coronary vasomotor dysfunction in patients with ANOCA. Most institutions recommend only testing the left coronary circulation. Therefore, it is unknown whether testing multiple coronary territories would increase diagnostic yield.

Objectives: The aim of this study was to evaluate the diagnostic yield of multivessel, compared with single-vessel, invasive coronary function testing (CFT) in patients with angina and nonobstructive coronary arteries (ANOCA).

Methods: Multivessel CFT was systematically performed in patients with suspected ANOCA. Vasoreactivity testing was performed using acetylcholine provocation in the left (20 to 200 μg) and right (20 to 80μg) coronary arteries. A pressure-temperature sensor guidewire was used for coronary physiology assessment in all three epicardial vessels.

Results: This multicenter study included a total of 228 vessels from 80 patients (57.8 ± 11.8 years of age, 60% women). Compared with single-vessel CFT, multivessel testing resulted in more patients diagnosed with coronary vasomotor dysfunction (86.3% vs 68.8%; P = 0.0005), coronary artery spasm (60.0% vs 47.5%; P = 0.004), and CMD (62.5% vs 36.3%; P < 0.001). Coronary artery spasm (n = 48) predominated in the left coronary system (n = 38), though isolated right coronary spasm was noted in 20.8% (n = 10). Coronary microvascular dysfunction (CMD), defined by abnormal index of microcirculatory resistance and/or coronary flow reserve, was present 62.5% of the cohort (n = 50). Among the cohort with CMD, 27 patients (33.8%) had 1-vessel CMD, 15 patients (18.8%) had 2-vessel CMD, and 8 patients (10%) had 3-vessel CMD. CMD was observed at a similar rate in the territories supplied by all 3 major coronary vessels (left anterior descending coronary artery = 36.3%, left circumflex coronary artery = 33.8%, right coronary artery = 31.3%; P = 0.486).

Conclusions: Multivessel CFT resulted in an increased diagnostic yield in patients with ANOCA compared with single-vessel testing. The results of this study suggest that multivessel CFT has a role in the management of patients with ANOCA.

Keywords: ANOCA; coronary artery spasm; coronary microvascular dysfunction; coronary vasomotor dysfunction; multivessel coronary function testing.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Rehan is supported by the National Health and Medical Research Council Postgraduate Scholarship. Dr Chan has received research support from Abbott Vascular. Dr Tremmel has received honoraria from Boston Scientific, Abbott Vascular, and Shockwave. Dr Fearon has received research support from Abbott Vascular and Medtronic; and has minor stock options with HeartFlow. Dr Ng has received research support from Abbott Vascular. Dr Yong has received minor honoraria and research support from Abbott Vascular, Boston Scientific and Philips Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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