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

94 Scopus citations

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 1 2012

Keywords

  • coronary reactivity
  • endothelial dysfunction
  • microvascular dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Wei, J., Mehta, P. K., Johnson, B. D., Samuels, B., Kar, S., Anderson, R. D., Azarbal, B., Petersen, J., Sharaf, B., Handberg, E., Shufelt, C., Kothawade, K., Sopko, G., Lerman, A., Shaw, L., Kelsey, S. F., Pepine, C. J., & Merz, C. N. B. (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, 5(6), 646-653. https://doi.org/10.1016/j.jcin.2012.01.023