WISE: Low risk associated with coronary reactivity testing in women with no obstructive CAD
Among women with suspected microvascular coronary dysfunction, coronary reactivity testing was found to be relatively safe and resulted in a low rate of adverse events, according to an analysis from the Women’s Ischemia Syndrome Evaluation, or WISE, study.
Researchers analyzed 293 symptomatic women with ischemia who did not have obstructive CAD. All women underwent coronary reactivity testing (CRT) at three experienced centers. Women were included in the study if they had angina, myocardial ischemia by stress testing and the absence of obstructive CAD defined as less than 50% luminal obstruction in one or more epicardial coronary arteries as determined by angiography. Researchers used Doppler wire and injections of adenosine, acetylcholine and nitroglycerin into the left coronary artery to determine microvascular function.
Overall, serious adverse events — which included hemodynamic instability, coronary artery dissection, MI, stroke and death — resulting from CRT occurred in two women (0.7%) during the procedure. Similarly, adverse events that included deep venous thrombosis, transient coronary air embolism, nonsustained arrhythmias and transient hypotension not requiring treatment were also reported in two women. No CRT-related deaths occurred.
During follow-up (mean, 5.4 years), the rate of major adverse CV events was 8.2%, and included five deaths, eight nonfatal MIs, eight nonfatal strokes and 11 hospitalizations for HF.
“These results support the use of CRT by experienced operators for establishing definitive diagnosis and assessing prognosis in this at-risk population,” the researchers said.