Author + information
- Received November 3, 2011
- Revision received January 13, 2012
- Accepted January 20, 2012
- Published online June 1, 2012.
- Janet Wei, MD⁎,
- Puja K. Mehta, MD⁎,
- B. Delia Johnson, PhD†,
- Bruce Samuels, MD⁎,
- Saibal Kar, MD‡,
- R. David Anderson, MD§,
- Babak Azarbal, MD‡,
- John Petersen, MD§,
- Barry Sharaf, MD∥,
- Eileen Handberg, PhD§,
- Chrisandra Shufelt, MD⁎,
- Kamlesh Kothawade, MBBS⁎,
- George Sopko, MD¶,
- Amir Lerman, MD#,
- Leslee Shaw, PhD⁎⁎,
- Sheryl F. Kelsey, PhD†,
- Carl J. Pepine, MD§ and
- C. Noel Bairey Merz, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. C. Noel Bairey Merz, Division of Cardiology, Women's Heart Center, Cedars-Sinai Medical Center, 444 South San Vicente Boulevard, Suite 600, Los Angeles, California 90048
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)
This work was supported by contracts from the National Heart, Lung, and Blood Institute, nos. N01-HV-68161, N01-HV-68162, N01-HV-68163, and N01-HV-68164; grants U0164829, U01 HL649141, U01 HL649241, T32HL69751, and 1R03AG032631 from the National Institute on Aging; General Clinical Research Center grant MO1-RR00425 from the National Center for Research Resources; and grants from the Gustavus and Louis Pfeiffer Research Foundation, Danville, New Jersey; The Women's Guild of Cedars-Sinai Medical Center, Los Angeles, California; The Ladies Hospital Aid Society of Western Pennsylvania, Pittsburgh, Pennsylvania; QMED, Inc., Laurence Harbor, New Jersey; the Edythe L. Broad Women's Heart Research Fellowship, Cedars-Sinai Medical Center, Los Angeles, California; and the Barbra Streisand Women's Cardiovascular Research and Education Program, Cedars-Sinai Medical Center, Los Angeles, California. Dr. Samuel received speaker's honoraria from Abbott Vascular and is a consultant for Volcano Corporation. Dr. Shufelt received an investigator research effort funding (>10,000/year) from Gilead. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Wei and Mehta contributed equally to this work.
- Received November 3, 2011.
- Revision received January 13, 2012.
- Accepted January 20, 2012.
- American College of Cardiology Foundation