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Ischemia With Nonobstructive Coronary Arteries: Insights From the ISCHEMIA Trial.

Publication ,  Journal Article
Reynolds, HR; Diaz, A; Cyr, DD; Shaw, LJ; Mancini, GBJ; Leipsic, J; Budoff, MJ; Min, JK; Hague, CJ; Berman, DS; Chaitman, BR; Picard, MH ...
Published in: JACC Cardiovasc Imaging
January 2023

BACKGROUND: Ischemia with nonobstructive coronary arteries (INOCA) is common clinically, particularly among women, but its prevalence among patients with at least moderate ischemia and the relationship between ischemia severity and non-obstructive atherosclerosis severity are unknown. OBJECTIVES: The authors investigated predictors of INOCA in enrolled, nonrandomized participants in ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches), sex differences, and the relationship between ischemia and atherosclerosis in patients with INOCA. METHODS: Core laboratories independently reviewed screening noninvasive stress test results (nuclear imaging, echocardiography, magnetic resonance imaging or nonimaging exercise tolerance testing), and coronary computed tomography angiography (CCTA), blinded to results of the screening test. INOCA was defined as all stenoses <50% on CCTA in a patient with moderate or severe ischemia on stress testing. INOCA patients, who were excluded from randomization, were compared with randomized participants with ≥50% stenosis in ≥1 vessel and moderate or severe ischemia. RESULTS: Among 3,612 participants with core laboratory-confirmed moderate or severe ischemia and interpretable CCTA, 476 (13%) had INOCA. Patients with INOCA were younger, were predominantly female, and had fewer atherosclerosis risk factors. For each stress testing modality, the extent of ischemia tended to be less among patients with INOCA, particularly with nuclear imaging. There was no significant relationship between severity of ischemia and extent or severity of nonobstructive atherosclerosis on CCTA. On multivariable analysis, female sex was independently associated with INOCA (odds ratio: 4.2 [95% CI: 3.4-5.2]). CONCLUSIONS: Among participants enrolled in ISCHEMIA with core laboratory-confirmed moderate or severe ischemia, the prevalence of INOCA was 13%. Severity of ischemia was not associated with severity of nonobstructive atherosclerosis. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522).

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Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

January 2023

Volume

16

Issue

1

Start / End Page

63 / 74

Location

United States

Related Subject Headings

  • Predictive Value of Tests
  • Myocardial Ischemia
  • Male
  • Ischemia
  • Humans
  • Female
  • Coronary Vessels
  • Coronary Artery Disease
  • Coronary Angiography
  • Cardiovascular System & Hematology
 

Citation

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Reynolds, H. R., Diaz, A., Cyr, D. D., Shaw, L. J., Mancini, G. B. J., Leipsic, J., … ISCHEMIA Research Group, . (2023). Ischemia With Nonobstructive Coronary Arteries: Insights From the ISCHEMIA Trial. JACC Cardiovasc Imaging, 16(1), 63–74. https://doi.org/10.1016/j.jcmg.2022.06.015
Reynolds, Harmony R., Ariel Diaz, Derek D. Cyr, Leslee J. Shaw, GB John Mancini, Jonathon Leipsic, Matthew J. Budoff, et al. “Ischemia With Nonobstructive Coronary Arteries: Insights From the ISCHEMIA Trial.JACC Cardiovasc Imaging 16, no. 1 (January 2023): 63–74. https://doi.org/10.1016/j.jcmg.2022.06.015.
Reynolds HR, Diaz A, Cyr DD, Shaw LJ, Mancini GBJ, Leipsic J, et al. Ischemia With Nonobstructive Coronary Arteries: Insights From the ISCHEMIA Trial. JACC Cardiovasc Imaging. 2023 Jan;16(1):63–74.
Reynolds, Harmony R., et al. “Ischemia With Nonobstructive Coronary Arteries: Insights From the ISCHEMIA Trial.JACC Cardiovasc Imaging, vol. 16, no. 1, Jan. 2023, pp. 63–74. Pubmed, doi:10.1016/j.jcmg.2022.06.015.
Reynolds HR, Diaz A, Cyr DD, Shaw LJ, Mancini GBJ, Leipsic J, Budoff MJ, Min JK, Hague CJ, Berman DS, Chaitman BR, Picard MH, Hayes SW, Scherrer-Crosbie M, Kwong RY, Lopes RD, Senior R, Dwivedi SK, Miller TD, Chow BJW, de Silva R, Stone GW, Boden WE, Bangalore S, O’Brien SM, Hochman JS, Maron DJ, ISCHEMIA Research Group. Ischemia With Nonobstructive Coronary Arteries: Insights From the ISCHEMIA Trial. JACC Cardiovasc Imaging. 2023 Jan;16(1):63–74.
Journal cover image

Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

January 2023

Volume

16

Issue

1

Start / End Page

63 / 74

Location

United States

Related Subject Headings

  • Predictive Value of Tests
  • Myocardial Ischemia
  • Male
  • Ischemia
  • Humans
  • Female
  • Coronary Vessels
  • Coronary Artery Disease
  • Coronary Angiography
  • Cardiovascular System & Hematology