Myocardial Ischemia Without Obstructive Coronary Stenoses

San Carlos Clinical Hospital

Status

Enrolling

Conditions

Vasospastic Angina

Myocardial Ischemia

Myocardial Bridging

Non-Obstructive Coronary Atherosclerosis

Microvascular Coronary Artery Disease

Treatments

Diagnostic Test: Invasive coronary endothelium-dependent and non-endothelium-dependent physiological assessment

Study type

Observational

Funder types

Other

Identifiers

NCT04827498

21/289-E

Details and patient eligibility

About

Coronary-related myocardial ischemia can result from obstructive epicardial stenosis or non-obstructive causes including coronary microcirculatory dysfunction and vasomotor disorders. This prospective study has been created in order to provide knowledge in the field of non-obstructive coronary artery disease.

Full description

All-comer patients referred for coronary physiological assessment with pressure-flow measurements and acetylcholine endothelial function test, aimed to investigate different aspects of non-obstructive coronary artery disease, will be enrolled. Coronary hemodynamics during adenosine or acetylcholine evaluation will be measured either with a physiology wire equipped with pressure and temperature sensors (Abbott), or with a physiology wire equipped with pressure sensor and Doppler (Philips). Non-endothelium-dependent functional assessment will be performed with intravenous or intracoronary adenosine administration following the standard practice. Endothelium-dependent functional assessment will be performed with intracoronary acetylcholine bolus administration following the standard practice, which includes continuous 12-lead ECG monitorization. Microcirculatory dysfunction and vasomotor disorders will be diagnosed according to the criteria from the last European expert consensus on Ischaemia with Non-Obstructive Coronary Arteries (INOCA). Medical therapy will be adjusted on the basis of physiology study results and patients will be followed at 30 days, 1-, 2- and 5-years either at the outpatient clinic or by telephone contact. The Seattle Questionnaire of Angina will be applied during follow-up for obtaining an objective characterisation of the angina status.

OBJECTIVES OF THE STUDY:

To investigate the coronary hemodynamics across the spectrum of coronary microcirculatory dysfunction.
To investigate the coronary hemodynamics across the spectrum of vasomotor disorders.
To investigate the impact of coronary microcirculatory dysfunction on clinical outcomes and patient symptoms at long-term follow-up.
To investigate the impact of coronary vasomotor disorders on clinical outcomes and patient symptoms at long-term follow-up.
To investigate the impact of a stratified medical therapy (guided by invasive physiology study) on patient symptoms.
To investigate the role of microcirculatory dysfunction and vasomotor disorders in different settings of ischemic heart disease (i.e., recurrent angina despite successful percutaneous coronary intervention; myocardial infarction without obstructive coronary artery disease; left ventricular dysfunction (either systolic or diastolic) with or without heart failure).
To develop new, alternative methods aimed to assess the coronary microcirculation.
To investigate the role of myocardial bridging on myocardial ischemia generating mechanisms.
To document safety of intracoronary testing in routine clinical practice.