Safety of coronary reactivity testing in women with no obstructive coronary artery disease: Results from the NHLBI-sponsored WISE (Women's Ischemia Syndrome Evaluation) study

Janet Wei, Puja K. Mehta, B. Delia Johnson, Bruce Samuels, Saibal Kar, R. David Anderson, Babak Azarbal, John Petersen, Barry Sharaf, Eileen Handberg, Chrisandra Shufelt, Kamlesh Kothawade, George Sopko, Amir Lerman, Leslee Shaw, Sheryl F. Kelsey, Carl J. Pepine, C. Noel Bairey Merz

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Objectives: This study evaluated the safety of coronary reactivity testing (CRT) in symptomatic women with evidence of myocardial ischemia and no obstructive coronary artery disease (CAD). Background: Microvascular coronary dysfunction (MCD) in women with no obstructive CAD portends an adverse prognosis of a 2.5% annual major adverse cardiovascular event (MACE) rate. The diagnosis of MCD is established by invasive CRT, yet the risk of CRT is unknown. Methods: The authors evaluated 293 symptomatic women with ischemia and no obstructive CAD, who underwent CRT at 3 experienced centers. Microvascular function was assessed using a Doppler wire and injections of adenosine, acetylcholine, and nitroglycerin into the left coronary artery. CRT-related serious adverse events (SAEs), adverse events (AEs), and follow-up MACE (death, nonfatal myocardial infarction [MI], nonfatal stroke, or hospitalization for heart failure) were recorded. Results: CRT-SAEs occurred in 2 women (0.7%) during the procedure: 1 had coronary artery dissection, and 1 developed MI associated with coronary spasm. CRT-AEs occurred in 2 women (0.7%) and included 1 transient air microembolism and 1 deep venous thrombosis. There was no CRT-related mortality. In the mean follow-up period of 5.4 years, the MACE rate was 8.2%, including 5 deaths (1.7%), 8 nonfatal MIs (2.7%), 8 nonfatal strokes (2.7%), and 11 hospitalizations for heart failure (3.8%). Conclusions: In women undergoing CRT for suspected MCD, contemporary testing carries a relatively low risk compared with the MACE rate in these women. These results support the use of CRT by experienced operators for establishing definitive diagnosis and assessing prognosis in this at-risk population. (Women's Ischemia Syndrome Evaluation [WISE]; NCT00832702).

Original languageEnglish (US)
Pages (from-to)646-653
Number of pages8
JournalJACC: Cardiovascular Interventions
Volume5
Issue number6
DOIs
StatePublished - Jun 2012

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National Heart, Lung, and Blood Institute (U.S.)
Coronary Artery Disease
Ischemia
Safety
Coronary Vessels
Hospitalization
Heart Failure
Stroke
Myocardial Infarction
Nitroglycerin
Spasm
Venous Thrombosis
Adenosine
Acetylcholine
Myocardial Ischemia
Dissection
Air
Injections
Mortality

Keywords

  • coronary reactivity
  • endothelial dysfunction
  • microvascular dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Safety of coronary reactivity testing in women with no obstructive coronary artery disease : Results from the NHLBI-sponsored WISE (Women's Ischemia Syndrome Evaluation) study. / Wei, Janet; Mehta, Puja K.; Johnson, B. Delia; Samuels, Bruce; Kar, Saibal; Anderson, R. David; Azarbal, Babak; Petersen, John; Sharaf, Barry; Handberg, Eileen; Shufelt, Chrisandra; Kothawade, Kamlesh; Sopko, George; Lerman, Amir; Shaw, Leslee; Kelsey, Sheryl F.; Pepine, Carl J.; Merz, C. Noel Bairey.

In: JACC: Cardiovascular Interventions, Vol. 5, No. 6, 06.2012, p. 646-653.

Research output: Contribution to journalArticle

Wei, J, Mehta, PK, Johnson, BD, Samuels, B, Kar, S, Anderson, RD, Azarbal, B, Petersen, J, Sharaf, B, Handberg, E, Shufelt, C, Kothawade, K, Sopko, G, Lerman, A, Shaw, L, Kelsey, SF, Pepine, CJ & Merz, CNB 2012, 'Safety of coronary reactivity testing in women with no obstructive coronary artery disease: Results from the NHLBI-sponsored WISE (Women's Ischemia Syndrome Evaluation) study', JACC: Cardiovascular Interventions, vol. 5, no. 6, pp. 646-653. https://doi.org/10.1016/j.jcin.2012.01.023
Wei, Janet ; Mehta, Puja K. ; Johnson, B. Delia ; Samuels, Bruce ; Kar, Saibal ; Anderson, R. David ; Azarbal, Babak ; Petersen, John ; Sharaf, Barry ; Handberg, Eileen ; Shufelt, Chrisandra ; Kothawade, Kamlesh ; Sopko, George ; Lerman, Amir ; Shaw, Leslee ; Kelsey, Sheryl F. ; Pepine, Carl J. ; Merz, C. Noel Bairey. / Safety of coronary reactivity testing in women with no obstructive coronary artery disease : Results from the NHLBI-sponsored WISE (Women's Ischemia Syndrome Evaluation) study. In: JACC: Cardiovascular Interventions. 2012 ; Vol. 5, No. 6. pp. 646-653.
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abstract = "Objectives: This study evaluated the safety of coronary reactivity testing (CRT) in symptomatic women with evidence of myocardial ischemia and no obstructive coronary artery disease (CAD). Background: Microvascular coronary dysfunction (MCD) in women with no obstructive CAD portends an adverse prognosis of a 2.5{\%} annual major adverse cardiovascular event (MACE) rate. The diagnosis of MCD is established by invasive CRT, yet the risk of CRT is unknown. Methods: The authors evaluated 293 symptomatic women with ischemia and no obstructive CAD, who underwent CRT at 3 experienced centers. Microvascular function was assessed using a Doppler wire and injections of adenosine, acetylcholine, and nitroglycerin into the left coronary artery. CRT-related serious adverse events (SAEs), adverse events (AEs), and follow-up MACE (death, nonfatal myocardial infarction [MI], nonfatal stroke, or hospitalization for heart failure) were recorded. Results: CRT-SAEs occurred in 2 women (0.7{\%}) during the procedure: 1 had coronary artery dissection, and 1 developed MI associated with coronary spasm. CRT-AEs occurred in 2 women (0.7{\%}) and included 1 transient air microembolism and 1 deep venous thrombosis. There was no CRT-related mortality. In the mean follow-up period of 5.4 years, the MACE rate was 8.2{\%}, including 5 deaths (1.7{\%}), 8 nonfatal MIs (2.7{\%}), 8 nonfatal strokes (2.7{\%}), and 11 hospitalizations for heart failure (3.8{\%}). Conclusions: In women undergoing CRT for suspected MCD, contemporary testing carries a relatively low risk compared with the MACE rate in these women. These results support the use of CRT by experienced operators for establishing definitive diagnosis and assessing prognosis in this at-risk population. (Women's Ischemia Syndrome Evaluation [WISE]; NCT00832702).",
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T2 - Results from the NHLBI-sponsored WISE (Women's Ischemia Syndrome Evaluation) study

AU - Wei, Janet

AU - Mehta, Puja K.

AU - Johnson, B. Delia

AU - Samuels, Bruce

AU - Kar, Saibal

AU - Anderson, R. David

AU - Azarbal, Babak

AU - Petersen, John

AU - Sharaf, Barry

AU - Handberg, Eileen

AU - Shufelt, Chrisandra

AU - Kothawade, Kamlesh

AU - Sopko, George

AU - Lerman, Amir

AU - Shaw, Leslee

AU - Kelsey, Sheryl F.

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AU - Merz, C. Noel Bairey

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N2 - Objectives: This study evaluated the safety of coronary reactivity testing (CRT) in symptomatic women with evidence of myocardial ischemia and no obstructive coronary artery disease (CAD). Background: Microvascular coronary dysfunction (MCD) in women with no obstructive CAD portends an adverse prognosis of a 2.5% annual major adverse cardiovascular event (MACE) rate. The diagnosis of MCD is established by invasive CRT, yet the risk of CRT is unknown. Methods: The authors evaluated 293 symptomatic women with ischemia and no obstructive CAD, who underwent CRT at 3 experienced centers. Microvascular function was assessed using a Doppler wire and injections of adenosine, acetylcholine, and nitroglycerin into the left coronary artery. CRT-related serious adverse events (SAEs), adverse events (AEs), and follow-up MACE (death, nonfatal myocardial infarction [MI], nonfatal stroke, or hospitalization for heart failure) were recorded. Results: CRT-SAEs occurred in 2 women (0.7%) during the procedure: 1 had coronary artery dissection, and 1 developed MI associated with coronary spasm. CRT-AEs occurred in 2 women (0.7%) and included 1 transient air microembolism and 1 deep venous thrombosis. There was no CRT-related mortality. In the mean follow-up period of 5.4 years, the MACE rate was 8.2%, including 5 deaths (1.7%), 8 nonfatal MIs (2.7%), 8 nonfatal strokes (2.7%), and 11 hospitalizations for heart failure (3.8%). Conclusions: In women undergoing CRT for suspected MCD, contemporary testing carries a relatively low risk compared with the MACE rate in these women. These results support the use of CRT by experienced operators for establishing definitive diagnosis and assessing prognosis in this at-risk population. (Women's Ischemia Syndrome Evaluation [WISE]; NCT00832702).

AB - Objectives: This study evaluated the safety of coronary reactivity testing (CRT) in symptomatic women with evidence of myocardial ischemia and no obstructive coronary artery disease (CAD). Background: Microvascular coronary dysfunction (MCD) in women with no obstructive CAD portends an adverse prognosis of a 2.5% annual major adverse cardiovascular event (MACE) rate. The diagnosis of MCD is established by invasive CRT, yet the risk of CRT is unknown. Methods: The authors evaluated 293 symptomatic women with ischemia and no obstructive CAD, who underwent CRT at 3 experienced centers. Microvascular function was assessed using a Doppler wire and injections of adenosine, acetylcholine, and nitroglycerin into the left coronary artery. CRT-related serious adverse events (SAEs), adverse events (AEs), and follow-up MACE (death, nonfatal myocardial infarction [MI], nonfatal stroke, or hospitalization for heart failure) were recorded. Results: CRT-SAEs occurred in 2 women (0.7%) during the procedure: 1 had coronary artery dissection, and 1 developed MI associated with coronary spasm. CRT-AEs occurred in 2 women (0.7%) and included 1 transient air microembolism and 1 deep venous thrombosis. There was no CRT-related mortality. In the mean follow-up period of 5.4 years, the MACE rate was 8.2%, including 5 deaths (1.7%), 8 nonfatal MIs (2.7%), 8 nonfatal strokes (2.7%), and 11 hospitalizations for heart failure (3.8%). Conclusions: In women undergoing CRT for suspected MCD, contemporary testing carries a relatively low risk compared with the MACE rate in these women. These results support the use of CRT by experienced operators for establishing definitive diagnosis and assessing prognosis in this at-risk population. (Women's Ischemia Syndrome Evaluation [WISE]; NCT00832702).

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KW - endothelial dysfunction

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