OR08-1
Characterizing Ischemia and Nonobstructive Coronary Arteries with Invasive Coronary Function Testing: First Report from the DISCOVER INOCA Multicenter Registry
Presenter
Dr. Samit M Shah, M.D., Ph.D., FSCAI, Yale New Haven Hospital, New Haven, CT
Dr. Samit M Shah, M.D., Ph.D., FSCAI1, Jennifer A. Tremmel, M.D., FSCAI2, Timothy D. Henry, M.D., MSCAI3, Nathaniel Rosso Smilowitz, MD, FSCAI4, Megha Prasad, M.D.5, Yuhei Kobayashi, MD6, Bruce Samuels7, Amir Lerman, M.D.8, Jeffrey W. Moses, MD, FSCAI9, Cody Pietras, BA10, Zhiyuan Zhang10, Daniela Tirziu, PhD10, Helen Parise, ScD10, Ecaterina Cristea, MD10, Daniel Chamie, MD10, Daniel Grubman, BS10, Kyna Henrici, RN10, Nida Latif, MBBS10, Natasha Cigarroa, MD1 and Alexandra J. Lansky, M.D., MSCAI11, (1)Yale New Haven Hospital, New Haven, CT, (2)Stanford University Medical Center, Stanford, CA, (3)The Christ Hospital Health Network, Covington, KY, (4)NYU Langone Medical Center, New York, NY, (5)NewYork-Presbyterian Columbia University Irving Medical Center, new york city, NY, (6)NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, (7)Cedars-Sinai Medical Center, Los Angeles, CA, (8)Mayo Clinic Health System Rochester, Rochester, MN, (9)NewYork-Presbyterian Columbia University Irving Medical Center, New York, NY, (10)Yale School of Medicine, New Haven, CT, (11)Yale University, New Haven, CT
Keywords: Coronary, Imaging & Physiology and Stable Ischemic Heart Disease (SIHD)
Background
:
DISCOVER INOCA is a prospective, multicenter registry that aims to characterize phenotypes of ischemia with nonobstructive coronary arteries (INOCA) and long-term outcomes based on physiologic assessment and anatomic evaluation of the extent of coronary artery disease (CAD) by quantitative angiography and intravascular imaging.
Methods
:
This registry, conducted at 9 centers in the United States, plans to enroll 500 patients with ischemic heart disease referred for angiography undergoing coronary function testing (CFT) for INOCA. All patients undergo protocol-guided angiography, acetylcholine provocation, coronary thermodilution, and intravascular imaging. The primary endpoint is the prevalence of INOCA phenotypes based on physiology and the degree of atherosclerosis. We report the initial interim patient characteristics of the population.
Results
:
From 9/2022 until 1/2024, 88 patients have been enrolled, 78% female, mean age of 56 ± 11 years. Access site was 75% radial and 21% femoral, with 8% radial/femoral transition. Angiographic findings included normal coronary arteries in 36 (44%) patients and nonobstructive CAD in 46 (56%). Operator-reported diagnosis included coronary microvascular dysfunction (CMD) in 15 (18%), vasospastic angina (VSA) in 31 (37%), myocardial bridging in 12 (15%), endothelial dysfunction in 17 (21%), mixed vasospasm + CMD in 11 (13%), and normal coronary physiology in 11 (13%). There was 1 procedural complication (1.2%). A change in pre-procedure diagnosis occurred in 74 patients (91%) and medication changes occurred in 62 (76%).
Conclusions
:
DISCOVER INOCA is the first prospective study of INOCA patients to integrate anatomic and physiologic measures of disease and correlate them with long-term outcomes.
Our initial findings confirm a predominance of female patients.
Physiologic testing was safe and changed the diagnosis and treatment of patients in the majority of cases.
Long-term outcomes will elucidate the value of a comprehensive diagnostic evaluation in patients with no obstructive CAD undergoing angiography.