Overview
The present study has the following objectives:
- To investigate the prevalence of INOCA in patients referring for a clinically indicated coronary angiography (CA) c/o Division of Cardiology - Federico II University Hospital;
- To stratify in INOCA endotypes patients according to the presence or absence of alternative (i.e. non obstructive CAD) causes of myocardial ischemia detected during CA clinically indicated through physiology tests;
- to implement a stratified therapy in these patients considering the different INOCA endotypes and evaluate the impact on angina class and quality of life as well as cardiac hospitalization and coronary revascularization during 5 year follow up
Description
Eligible patients with angina and/or positive stress test undergoing clinical indicated CA detecting non-obstructive CAD will be studied as follows:
- Functional evaluation by fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), Resting Full-Cycle Ratio (RFR) of any stenosis that is angiographically considered > 50%;
- In case of stenosis <50% or >50% but with negative functional evaluation (FFR >0.80 and iFR/RFR
>0.90), coronary flow reserve (CFR) and index of microvascular resistance (IMR) will be performed. IMR and CFR will be evaluated, using an intracoro- nary wire;
- In case of CFR>2.0 and IMR<25, acetylcholine test will be performed. Intracoronary acetylcholine (ACh) will be administrated to detect epicardial (focal or diffuse) or microvascular spasm.
Eligibility
Inclusion Criteria:
- Clinical presentation of chronic ischemic heart dis- ease (IHD), requiring coronary angiography for the diagnosis;
- Absence of obstructive coronary artery disease (CAD) at coronary angiography;
- Age &gt; 18 years.
- Ability to provide a valid informed consent to the study procedure at the time of baseline evaluation;
Exclusion Criteria:
Clinical presentation of acute coronary syndrome (ACS) or cardiogenic shock;
- Presence of obstructive CAD with at least 1 significant coronary artery stenosis, defined as diameterstenosis &gt;50% and FFR ≤0.80 (or iFR/RFR ≤0.89);
- Previous coronary artery bypass grafting (CABG);
- Left ventricular systolic dysfunction, defined as ejection fraction (EF) &lt;40%;
- Severe valvular heart disease;
- Pregnant or breastfeeding women
- Known hypersensitivity or contraindication to any of the drugs used for coronary physiology testing (adenosine, nitrates, acetylcholine)
- Inability or unwillingness to provide a valid in- formed consent to the study procedure at the time of baseline evaluation.