Document Detail


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.
MedLine Citation:
PMID:  22721660     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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).
Authors:
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
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  5     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-06-22     Completed Date:  2012-10-29     Revised Date:  2013-07-12    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  646-53     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardiology, Women's Heart Center, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00832702
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MeSH Terms
Descriptor/Qualifier:
Acetylcholine / diagnostic use
Adenosine / diagnostic use
Adult
Blood Flow Velocity
Coronary Angiography* / adverse effects
Coronary Circulation*
Coronary Vessels / physiopathology*
Female
Heart Failure / etiology,  mortality,  physiopathology
Hospitalization
Humans
Laser-Doppler Flowmetry*
Microcirculation*
Middle Aged
Myocardial Infarction / etiology,  mortality,  physiopathology
Myocardial Ischemia / complications,  diagnosis*,  mortality,  physiopathology
Nitroglycerin / diagnostic use
Predictive Value of Tests
Prognosis
Risk Assessment
Risk Factors
Stroke / etiology,  mortality,  physiopathology
United States
Vasodilator Agents / adverse effects,  diagnostic use*
Grant Support
ID/Acronym/Agency:
1R03AG032631/AG/NIA NIH HHS; MO1-RR00425/RR/NCRR NIH HHS; N01-HV-68161/HV/NHLBI NIH HHS; N01-HV-68162/HV/NHLBI NIH HHS; N01-HV-68163/HV/NHLBI NIH HHS; N01-HV-68164/HV/NHLBI NIH HHS; R01 HL090957/HL/NHLBI NIH HHS; T32HL69751/HL/NHLBI NIH HHS; U01 HL649141/HL/NHLBI NIH HHS; U01 HL649241/HL/NHLBI NIH HHS; U0164829//PHS HHS; UL1 TR000064/TR/NCATS NIH HHS; UL1 TR000124/TR/NCATS NIH HHS
Chemical
Reg. No./Substance:
0/Vasodilator Agents; 51-84-3/Acetylcholine; 55-63-0/Nitroglycerin; 58-61-7/Adenosine
Comments/Corrections
Comment In:
JACC Cardiovasc Interv. 2012 Jun;5(6):654-5   [PMID:  22721661 ]

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