Abstract 19546: Differential Event Prediction Using Coronary Vascular Testing Results From the National Heart, Lung and Blood Institute Women’s Ischemia Syndrome Evaluation Study

Background: Prior studies demonstrated that among women with signs and symptoms of ischemia but no obstructive coronary artery disease (CAD), invasive coronary vascular testing predicts combined shorter-term adverse events. Adenosine is commonly used in coronary angiography, while acetylcholine testing is not. We compared the prognostic value of adenosine based coronary flow reserve (CFR) measurement to acetylcholine based coronary vasodilation on differential longer-term outcomes from the WISE cohort. Methods: 200 women with signs and symptoms of ischemia with dominantly non-obstructive coronary artery disease underwent coronary vascular testing. CFR with adenosine and change in coronary artery diameter in response to intracoronary acetylcholine (IC-Ach) were evaluated. Cardio-vascular (CV) events (CV mortality or non-fatal myocardial infarction [MI], heart failure hospitalization (HF), or stroke) and angina hospitalization served as outcome variables over a median follow-up of 6 years. Kaplan-Meier analysis was used to evaluate the results of coronary vascular function. Results: Mean age was 56±10 years, 75% had non-obstructive CAD, 27% were diabetic, 61% had hypertension and 60% had hyperlipidemia. CFR Conclusion: Among women with signs and symptoms of ischemia with dominantly non-obstructive CAD, coronary vascular testing using adenosine based CFR predicts CV events, while IC-Ach predicts angina hospitalization. These data suggest that the easier and more commonly used adenosine based CFR testing offers prognostic data for CV death, MI, HF and stroke while IC-Ach is useful to predict angina hospitalization.